Provider Demographics
NPI:1144226614
Name:LUPA, KAREN FRANCES (MSN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:FRANCES
Last Name:LUPA
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:FRANCES
Other - Last Name:ELISBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM, APNP
Mailing Address - Street 1:PO BOX 778789
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-8789
Mailing Address - Country:US
Mailing Address - Phone:414-672-1353
Mailing Address - Fax:
Practice Address - Street 1:1032 S CESAR E CHAVEZ DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2203
Practice Address - Country:US
Practice Address - Phone:414-672-1353
Practice Address - Fax:414-672-4265
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI292363LA2200X
WI64443-032367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39901000Medicaid
WIML0193970OtherDEA
WIML0193970OtherDEA
WI521805Medicare Oscar/Certification
WIPO 0290Medicare UPIN
WI39901000Medicaid