Provider Demographics
NPI:1740746833
Name:LUPER, RANAE
Entity Type:Individual
Prefix:
First Name:RANAE
Middle Name:
Last Name:LUPER
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 1:10903 US HIGHWAY 412
Mailing Address - Street 2:
Mailing Address - City:KANSAS
Mailing Address - State:OK
Mailing Address - Zip Code:74347-1689
Mailing Address - Country:US
Mailing Address - Phone:918-506-0929
Mailing Address - Fax:
Practice Address - Street 1:10903 US HIGHWAY 412
Practice Address - Street 2:
Practice Address - City:KANSAS
Practice Address - State:OK
Practice Address - Zip Code:74347-1689
Practice Address - Country:US
Practice Address - Phone:918-506-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator