Provider Demographics
NPI:1437954922
Name:LUPERCIO, KIMBERLY RANAE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RANAE
Last Name:LUPERCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 CORNHUSKER HWY TRLR 49C
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-3718
Mailing Address - Country:US
Mailing Address - Phone:402-770-6232
Mailing Address - Fax:
Practice Address - Street 1:3700 CORNHUSKER HWY TRLR 150L
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3712
Practice Address - Country:US
Practice Address - Phone:402-770-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty