1306503396 NPI number — DR. DAVID EMANUEL LUP DNP, FNP-C

Table of content: DR. DAVID EMANUEL LUP DNP, FNP-C (NPI 1306503396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306503396 NPI number — DR. DAVID EMANUEL LUP DNP, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUP
Provider First Name:
DAVID
Provider Middle Name:
EMANUEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, FNP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306503396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7155 W WILLOW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85381-6062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-300-6581
Provider Business Mailing Address Fax Number:
623-321-8488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7155 W WILLOW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-6062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-300-6581
Provider Business Practice Location Address Fax Number:
623-321-8488
Provider Enumeration Date:
11/24/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN197310 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 271415 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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