Provider Demographics
NPI:1902135007
Name:FRY, LUPITA ANN (RN)
Entity Type:Individual
Prefix:
First Name:LUPITA
Middle Name:ANN
Last Name:FRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 FLAT RIVER DR
Mailing Address - Street 2:APT. 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-5343
Mailing Address - Country:US
Mailing Address - Phone:704-496-0088
Mailing Address - Fax:
Practice Address - Street 1:1716 FLAT RIVER DR
Practice Address - Street 2:APT. 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5343
Practice Address - Country:US
Practice Address - Phone:704-496-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide