Provider Demographics
NPI:1912057191
Name:LUPIA BLASI, COURTNEY G (RN, WHNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:G
Last Name:LUPIA BLASI
Suffix:
Gender:F
Credentials:RN, WHNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:G
Other - Last Name:LUPIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, WHNP
Mailing Address - Street 1:400 S 4TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6207
Mailing Address - Country:US
Mailing Address - Phone:888-731-8994
Mailing Address - Fax:
Practice Address - Street 1:400 S 4TH ST STE 500
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6207
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2038096363LW0102X
CO176701163W00000X
NV820830363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
CO19077734Medicaid
MNENROLLEDMedicaid