Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1043851017 |
---|---|
Provider Name | Kelly Lupo |
First Address | Scottsdale, AZ 85255-4924 |
Second Address | Scottsdale, AZ 85255-4924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2019 |
Last Update Date | 01/10/2019 |