Provider Demographics
NPI:1891113387
Name:DUBUISSON, MICHAELLE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELLE
Middle Name:
Last Name:DUBUISSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:MICHAELLE
Other - Middle Name:
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:555 FRENCH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1070
Mailing Address - Country:US
Mailing Address - Phone:315-735-9785
Mailing Address - Fax:315-724-3255
Practice Address - Street 1:555 FRENCH RD STE 103
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1070
Practice Address - Country:US
Practice Address - Phone:937-866-1821
Practice Address - Fax:937-866-1821
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025702363LF0000X
NYF345400-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty