Basic Information
| Provider Information | |||||||||
| NPI: | 1518157932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUPER | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | HOPE HINSHAW | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C.N.M.,M.S.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602362 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367655470 | ||||||||
| FaxNumber: | 3364995428 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 CHARLOIS BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271031522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367655470 | ||||||||
| FaxNumber: | 3364995428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 98250 | NC | N | Nursing Service Providers | Registered Nurse | 367A00000X | 237 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 7002209 | 05 | NC | MEDICAID |