Provider Demographics
NPI:1811223068
Name:WREAD, LUPINE M (LAC)
Entity Type:Individual
Prefix:
First Name:LUPINE
Middle Name:M
Last Name:WREAD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 S GWIN RD
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-5805
Mailing Address - Country:US
Mailing Address - Phone:530-277-5625
Mailing Address - Fax:707-822-4330
Practice Address - Street 1:1968 S GWIN RD
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-5805
Practice Address - Country:US
Practice Address - Phone:530-277-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12882171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist