MEDICARE: MRS. KATHLEEN A LUPONE RN,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	RN040006	AZ

General Provider Information

NPI Number	:	1457358764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN A LUPONE RN,FNP-C

Provider Business Mailing Address
First Line	:	5017 W ASTER DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-2013
Country	:	US
Telephone Number	:	602-978-6349
Fax Number	:	602-978-6349

Provider Business Practice Location Address
First Line	:	5111 N SCOTTSDALE RD STE 203
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-7077
Country	:	US
Telephone Number	:	480-771-3400
Fax Number	:	602-753-3042

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	02/25/2019

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