Provider Demographics
NPI:1972013852
Name:DUFAULT, KATELYN MARIE ROCK (NP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE ROCK
Last Name:DUFAULT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ROCK
Other - Last Name:LAUBAUSKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:159 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5638
Mailing Address - Country:US
Mailing Address - Phone:207-743-2945
Mailing Address - Fax:207-744-6570
Practice Address - Street 1:159 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5638
Practice Address - Country:US
Practice Address - Phone:207-743-2945
Practice Address - Fax:207-744-6570
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP171150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily