Provider Demographics
NPI:1750676888
Name:RUPKALVIS, CAROL ANNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:RUPKALVIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 PINE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-2061
Mailing Address - Country:US
Mailing Address - Phone:210-662-6468
Mailing Address - Fax:
Practice Address - Street 1:5126 PINE LAKE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-2061
Practice Address - Country:US
Practice Address - Phone:210-662-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223040363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health