Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN072457 | GA |
NPI | 1053369249 |
---|---|
Provider Name | Ms. Julia S. Lupa |
First Address | Lawrenceville, GA 30046 |
Second Address | Lawrenceville, GA 30046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 18/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500030756 | RAILROAD MEDICARE (01) | GA |
963939442A | (05) | GA |
P79584 | (02) | GA |