Provider Demographics
NPI:1104294107
Name:DUPRAT-FABRE, CERESTE
Entity type:Individual
Prefix:MRS
First Name:CERESTE
Middle Name:
Last Name:DUPRAT-FABRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CERESTE
Other - Middle Name:
Other - Last Name:DUPRAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:8831 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9664
Mailing Address - Country:US
Mailing Address - Phone:269-369-3423
Mailing Address - Fax:
Practice Address - Street 1:8831 TAMARACK LN
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9664
Practice Address - Country:US
Practice Address - Phone:269-369-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704227760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily