Healthcare Provider Details

I. General information

NPI: 1952454480
Provider Name (Legal Business Name): MICHELLE D LUPIEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 N 24TH ST
MESA AZ
85213-1435
US

IV. Provider business mailing address

2424 N. 24TH STREET
MESA AZ
85213
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-7553
  • Fax: 480-472-7549
Mailing address:
  • Phone: 480-472-7553
  • Fax: 480-472-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN104165
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: