Provider Demographics
NPI:1700432994
Name:DUPUIS, LOREN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:ELIZABETH
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LOREN
Other - Middle Name:ELIZABETH
Other - Last Name:DANESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:30 COURTENAY DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-3530
Practice Address - Country:US
Practice Address - Phone:843-792-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0001329363A00000X
SCMPA.3287363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant