Provider Demographics
NPI:1306273578
Name:LUPO, MOLLY R (DNP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:R
Last Name:LUPO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 NICHOLAS ST STE 106
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2188
Mailing Address - Country:US
Mailing Address - Phone:402-922-8783
Mailing Address - Fax:402-698-8033
Practice Address - Street 1:10020 NICHOLAS ST STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2188
Practice Address - Country:US
Practice Address - Phone:402-922-8783
Practice Address - Fax:402-698-8033
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112086363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX327819401Medicaid
TX323198YKQHMedicare PIN
TX8784NDOtherBCBS