Provider Demographics
NPI:1871593939
Name:DAUPHINAIS, VICKIE (APRN)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:DAUPHINAIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PECK RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6107
Mailing Address - Country:US
Mailing Address - Phone:860-489-6899
Mailing Address - Fax:860-489-1206
Practice Address - Street 1:52 PECK RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790
Practice Address - Country:US
Practice Address - Phone:860-489-6899
Practice Address - Fax:860-489-1206
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002793363LG0600X
CT2793363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004226222Medicaid
CTP71960Medicare UPIN
CT004226222Medicaid