Provider Demographics
NPI:1154541589
Name:LUPIEN, ALFRED ERWIN (PHD, CRNA)
Entity type:Individual
Prefix:PROF
First Name:ALFRED
Middle Name:ERWIN
Last Name:LUPIEN
Suffix:
Gender:M
Credentials:PHD, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25950 ANDERSEN AVE.
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033
Mailing Address - Country:US
Mailing Address - Phone:605-323-9503
Mailing Address - Fax:
Practice Address - Street 1:3932 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6513
Practice Address - Country:US
Practice Address - Phone:605-322-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN119798367500000X
SDCR000660367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered