Provider Demographics
NPI:1760942452
Name:UPPULURI, ELIZABETH MARY (WHNP-BC, CNM)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARY
Last Name:UPPULURI
Suffix:
Gender:F
Credentials:WHNP-BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ZABILA ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1823
Mailing Address - Country:US
Mailing Address - Phone:949-449-6505
Mailing Address - Fax:
Practice Address - Street 1:1353 OLD TEMESCAL RD STE 103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7257
Practice Address - Country:US
Practice Address - Phone:951-547-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010427363LW0102X
CANMW235982176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty