Healthcare Provider Details

I. General information

NPI: 1598965394
Provider Name (Legal Business Name): ELLEN LOFQUIST DUPERRET R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5630 N PLACITA AMANECER
TUCSON AZ
85718-4002
US

IV. Provider business mailing address

5630 N PLACITA AMANECER
TUCSON AZ
85718-4002
US

V. Phone/Fax

Practice location:
  • Phone: 520-615-6269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: