Provider Demographics
NPI:1285625855
Name:RUPPE, ELENA P (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:P
Last Name:RUPPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:413 OWEN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3411
Mailing Address - Country:US
Mailing Address - Phone:910-323-9111
Mailing Address - Fax:910-484-2535
Practice Address - Street 1:413 OWEN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3411
Practice Address - Country:US
Practice Address - Phone:910-323-9111
Practice Address - Fax:910-484-2535
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ23461Medicare UPIN
NC2760900Medicare ID - Type Unspecified