Provider Demographics
NPI:1013979889
Name:LUPE, PATRICIA J (CNM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:LUPE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-989-5111
Mailing Address - Fax:440-989-5123
Practice Address - Street 1:910 LIBERTY BELL DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1234
Practice Address - Country:US
Practice Address - Phone:440-989-5111
Practice Address - Fax:440-989-5123
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOANM311367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0590034Medicaid
OHLUNM01549Medicare PIN
OH0590034Medicaid
OH0590034Medicaid