Provider Demographics
NPI:1568744753
Name:DUMOUCHELLE, MARY E (MS, RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:DUMOUCHELLE
Suffix:
Gender:F
Credentials:MS, RN, FNP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:BUFFENBARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 HOSPITAL DR
Mailing Address - Street 2:STE 300
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2860
Mailing Address - Country:US
Mailing Address - Phone:740-566-4644
Mailing Address - Fax:740-566-4625
Practice Address - Street 1:55 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2302
Practice Address - Country:US
Practice Address - Phone:740-566-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH311545163W00000X
OH12422-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse