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NPI Code Detail

MEDICARE: LEEANNA RAE TUPEK

MEDICARE:   LEEANNA RAE TUPEK
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
1363A00000XPhysician Assistant0010-15853NC

General Provider Information

NPI Number : 1821987314
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEEANNA RAE TUPEK
Provider Business Mailing Address
First Line : PO BOX 5105
Second Line :
City : BELFAST
State : ME
Zip : 04915-5100
Country : US
Telephone Number : 910-332-3800
Fax Number : 910-251-0421
Provider Business Practice Location Address
First Line : 3787 SHIPYARD BLVD
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6148
Country : US
Telephone Number : 910-332-3800
Fax Number : 910-251-0421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2025
Last Update Date : 02/16/2026

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Directions to “ LEEANNA RAE TUPEK ” Practice Location

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