Provider Demographics
NPI:1568048924
Name:LUPIO, SUSAN DENISSE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISSE
Last Name:LUPIO
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 1:418 RAYBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98252-8655
Mailing Address - Country:US
Mailing Address - Phone:425-229-9444
Mailing Address - Fax:
Practice Address - Street 1:418 RAYBIRD AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-8655
Practice Address - Country:US
Practice Address - Phone:425-229-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC55038171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter