MEDICARE: BONNIE A LUPO MS, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F332123-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952306276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE A LUPO MS, FNP-C

Provider Business Mailing Address
First Line	:	1700 WALKER LAKE ONTARIO RD
Second Line	:
City	:	HILTON
State	:	NY
Zip	:	14468-9161
Country	:	US
Telephone Number	:	585-964-7622
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 WALKER LAKE ONTARIO RD
Second Line	:
City	:	HILTON
State	:	NY
Zip	:	14468-9161
Country	:	US
Telephone Number	:	585-964-7622
Fax Number	:	585-425-5295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/09/2007

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