Provider Demographics
NPI:1558456152
Name:SEDLAK LUPONE, MARIE L (CRNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:SEDLAK LUPONE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639295 DEPT 93394
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:484-346-1692
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:7800 SHOAL CREEK BLVD STE 130W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1040
Practice Address - Country:US
Practice Address - Phone:512-407-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023036512363LF0000X
PASP007668363LF0000X
TX1020694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily