Provider Demographics
NPI:1538706593
Name:DAUPHINAIS, TORI MARIE LEWIS (CRNP)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:MARIE LEWIS
Last Name:DAUPHINAIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:28227 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-3239
Mailing Address - Country:US
Mailing Address - Phone:301-884-8161
Mailing Address - Fax:301-475-7039
Practice Address - Street 1:28227 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3239
Practice Address - Country:US
Practice Address - Phone:301-884-8161
Practice Address - Fax:301-475-7039
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR222774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily