Provider Demographics
NPI:1598100455
Name:LUPO, TERRY B
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:B
Last Name:LUPO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TERRY
Other - Middle Name:A
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2720 BRICKMILL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7911
Mailing Address - Country:US
Mailing Address - Phone:843-856-9246
Mailing Address - Fax:
Practice Address - Street 1:4542 SIMMS AVE
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5256
Practice Address - Country:US
Practice Address - Phone:843-529-4616
Practice Address - Fax:843-529-3903
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN.36325163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool