Provider Demographics
NPI:1891398343
Name:DUFOUR, MICHAEL WESLEY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WESLEY
Last Name:DUFOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4078 WINGATE CT
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-2291
Mailing Address - Country:US
Mailing Address - Phone:144-022-8061
Mailing Address - Fax:
Practice Address - Street 1:4078 WINGATE CT
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-2291
Practice Address - Country:US
Practice Address - Phone:144-022-8061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide