MEDICARE: ELLEN LOFQUIST DUPERRET R.D.

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	133VN1004X	Pediatric Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1598965394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN LOFQUIST DUPERRET R.D.

Provider Business Mailing Address
First Line	:	5630 N PLACITA AMANECER
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-4002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5630 N PLACITA AMANECER
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-4002
Country	:	US
Telephone Number	:	520-615-6269
Fax Number	:

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/19/2007

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