Provider Demographics
NPI:1982646600
Name:STUPKA, ANNE S (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:S
Last Name:STUPKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CHARLOIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1522
Mailing Address - Country:US
Mailing Address - Phone:336-768-5834
Mailing Address - Fax:336-765-4889
Practice Address - Street 1:160 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1522
Practice Address - Country:US
Practice Address - Phone:336-768-5834
Practice Address - Fax:336-765-4889
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600083363L00000X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003509Medicaid
NC7003509Medicaid