Individual
LORI STUPP-BOBULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3200 VINE ST, CINCINNATI, OH 45220-2213
(513) 475-6509
Mailing address
3200 VINE ST, CINCINNATI, OH 45220-2213
(513) 475-6509
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
004787
NY
363A00000X
Physician Assistant
085004287
IL
363A00000X
Physician Assistant
25MP00071900
NJ
363A00000X
Physician Assistant
Primary
4787-01
NY
363A00000X
Physician Assistant
50.003029
OH
363A00000X
Physician Assistant
PA 1739
KY
363A00000X
Physician Assistant
PA9109437
FL
Other
Enumeration date
06/16/2006
Last updated
06/09/2020
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