1669719779 NPI number — MRS. ASHLEY E LUPICO M.A, TLLP

Table of content: MRS. ASHLEY E LUPICO M.A, TLLP (NPI 1669719779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669719779 NPI number — MRS. ASHLEY E LUPICO M.A, TLLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUPICO
Provider First Name:
ASHLEY
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A, TLLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WANCOUR
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., TLLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669719779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52456 FAYETTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48316-3054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-246-2055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42140 VAN DYKE AVE STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48314-3676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-656-4052
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2013

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: 103T00000X , with the licence number:  6301015309 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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