Provider Demographics
NPI:1780309039
Name:KUPPEL, MANDI RANEE (NP)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:RANEE
Last Name:KUPPEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2239
Mailing Address - Country:US
Mailing Address - Phone:716-363-6050
Mailing Address - Fax:833-974-1992
Practice Address - Street 1:75 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2239
Practice Address - Country:US
Practice Address - Phone:716-366-6036
Practice Address - Fax:833-974-1992
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily