Provider Demographics
NPI:1467100859
Name:DUPUIS, JOEL EBEN (PMHNP)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:EBEN
Last Name:DUPUIS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4347
Mailing Address - Country:US
Mailing Address - Phone:541-556-6743
Mailing Address - Fax:530-339-7557
Practice Address - Street 1:1655 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4347
Practice Address - Country:US
Practice Address - Phone:541-556-6743
Practice Address - Fax:530-339-7557
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201141589RN163WG0000X
OR10023447363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice