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General NPI Number Information
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NPI Number | 1174567374
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Entity Type | Individual
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Provider Name | LORI STUPP-BOBULA PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 3200 VINE ST
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City | CINCINNATI
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State | OH
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Zip | 45220-2213
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Country | US
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Telephone | 513-475-6509
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 VINE ST
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City | CINCINNATI
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State | OH
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Zip | 45220-2213
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Country | US
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Telephone | 513-475-6509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109437
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00071900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 1739
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085004287
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.003029
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004787
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4787-01
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License Number State | NY
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