Provider Demographics
NPI:1700357415
Name:DUPITON, MONALISA (LPN)
Entity Type:Individual
Prefix:
First Name:MONALISA
Middle Name:
Last Name:DUPITON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MYSTERY LN
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01331-9542
Mailing Address - Country:US
Mailing Address - Phone:978-290-1124
Mailing Address - Fax:978-401-2148
Practice Address - Street 1:94 MYSTERY LN
Practice Address - Street 2:
Practice Address - City:PHILLIPSTON
Practice Address - State:MA
Practice Address - Zip Code:01331-9542
Practice Address - Country:US
Practice Address - Phone:978-290-1124
Practice Address - Fax:978-401-2148
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN57197164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1588161053OtherNA