| NPI | 1063696516 |
|---|---|
| Former Name | THERESE ANN LUPONE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 3319-033) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 3319-033) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2009-02-04 |