Provider Demographics
NPI:1891290839
Name:DUPREY, ROBERT JUSTIN (FNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JUSTIN
Last Name:DUPREY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-8449
Mailing Address - Country:US
Mailing Address - Phone:217-474-1914
Mailing Address - Fax:
Practice Address - Street 1:707 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4360
Practice Address - Country:US
Practice Address - Phone:217-446-6410
Practice Address - Fax:217-477-4757
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF03180890363L00000X, 363LF0000X
IN28249457A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner