Provider Demographics
NPI:1063816304
Name:DUPREE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DUPREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71061-0222
Mailing Address - Country:US
Mailing Address - Phone:337-501-6055
Mailing Address - Fax:
Practice Address - Street 1:7655 GRIMM RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-3450
Practice Address - Country:US
Practice Address - Phone:337-501-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00743174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist