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General NPI Number Information
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NPI Number | 1720588486
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Entity Type | Individual
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Provider Name | LUPITA ANN WEATHERWAX APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 3100 N GLASSFORD HILL RD
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2285
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Country | US
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Telephone | 928-777-7820
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Fax | 928-777-7821
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Provider Business Mailing Address
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Address Line | 2790 N KINGS HWY W
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2808
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Country | US
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Telephone | 928-261-3375
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 248936
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License Number State | AZ
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