Individual
CHERYL DUPUIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110
(573) 635-5264
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-001162
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010688
MEDICARE GROUP PTAN
MO
05
—
1104010412
—
MO
01
—
CP9089
RAILROAD GROUP
MO
01
—
P00635927
MEDICARE RAIROAD
MO
Enumeration date
08/29/2007
Last updated
12/22/2008
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