Provider Demographics
NPI:1669587036
Name:SCHUPP, NANCY LEE (ANP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:SCHUPP
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1867 AIRPORT WAY
Mailing Address - Street 2:STE 140A
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4055
Mailing Address - Country:US
Mailing Address - Phone:907-457-9355
Mailing Address - Fax:907-457-9356
Practice Address - Street 1:1640 COWLES ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5925
Practice Address - Country:US
Practice Address - Phone:907-452-4768
Practice Address - Fax:907-452-1009
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK7363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP7619Medicaid
AKR56962Medicare UPIN
AKK162482Medicare PIN
AKK160115Medicare ID - Type Unspecified