Provider Demographics
NPI:1023304870
Name:LUPTON, PATRICIA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:LUPTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MARTIN L KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4234
Mailing Address - Country:US
Mailing Address - Phone:253-459-7956
Mailing Address - Fax:253-459-7861
Practice Address - Street 1:315 MARTIN L KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4234
Practice Address - Country:US
Practice Address - Phone:253-459-7956
Practice Address - Fax:253-459-7861
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1578363A00000X
MN10974363A00000X
WAPA60638457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNP01241713OtherMEDICARE RAILROAD
MN970005547Medicare PIN