Provider Demographics
NPI:1306135462
Name:DUBOIS, JACQUES DOMINIC (RN)
Entity type:Individual
Prefix:MR
First Name:JACQUES
Middle Name:DOMINIC
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 BRIMHALL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2430
Mailing Address - Country:US
Mailing Address - Phone:651-698-8115
Mailing Address - Fax:
Practice Address - Street 1:308 BRIMHALL ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2430
Practice Address - Country:US
Practice Address - Phone:651-698-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN188706-0163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN188706-0OtherMINNESOTA BOARD OF NURSING