Provider Demographics
NPI:1063280519
Name:LUPARDUS, ANNE (PNP)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:LUPARDUS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 E 5TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3130
Mailing Address - Country:US
Mailing Address - Phone:573-673-3220
Mailing Address - Fax:
Practice Address - Street 1:851 E 5TH ST STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3130
Practice Address - Country:US
Practice Address - Phone:314-239-8555
Practice Address - Fax:314-239-9444
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021001814363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics