Provider Demographics
NPI:1306271879
Name:DUPUIS, SCOTT NELSON
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:NELSON
Last Name:DUPUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:NELSON
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3548 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4119
Mailing Address - Country:US
Mailing Address - Phone:612-822-8227
Mailing Address - Fax:
Practice Address - Street 1:3548 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4119
Practice Address - Country:US
Practice Address - Phone:612-822-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program