Provider Demographics
NPI:1760038285
Name:DUFOUR, JESSICA RAE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:DUFOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-2636
Mailing Address - Country:US
Mailing Address - Phone:814-553-4860
Mailing Address - Fax:
Practice Address - Street 1:1789 S BRADDOCK AVE STE 410
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1881
Practice Address - Country:US
Practice Address - Phone:412-247-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020668363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health