Provider Demographics
NPI:1396729778
Name:CHUPP, LORI J (M PA-S)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:J
Last Name:CHUPP
Suffix:
Gender:F
Credentials:M PA-S
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11231 BRIDGER PL
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8012
Mailing Address - Country:US
Mailing Address - Phone:907-622-7722
Mailing Address - Fax:
Practice Address - Street 1:5955 ZEAMER AVE
Practice Address - Street 2:3 MDOS / SGOEF
Practice Address - City:ELMENDORF AFB
Practice Address - State:AK
Practice Address - Zip Code:99506-3702
Practice Address - Country:US
Practice Address - Phone:907-580-2318
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1032481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant