Provider Demographics
NPI:1912743246
Name:KUPERSHMIDT, DEMITRIA (FNP)
Entity type:Individual
Prefix:
First Name:DEMITRIA
Middle Name:
Last Name:KUPERSHMIDT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 DON PIO DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4269
Mailing Address - Country:US
Mailing Address - Phone:818-770-8999
Mailing Address - Fax:
Practice Address - Street 1:4312 WOODMAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-5523
Practice Address - Country:US
Practice Address - Phone:818-770-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily