Provider Demographics
NPI:1386153724
Name:RUPE, CARRIE LEIGH (MPAS)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEIGH
Last Name:RUPE
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LEIGH
Other - Last Name:CUBBERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR STE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:5315 ELLIOTT DR STE 304
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8634
Practice Address - Country:US
Practice Address - Phone:734-712-0655
Practice Address - Fax:734-887-0652
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60794994363A00000X
MI5601009462363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2088768Medicaid