MEDICARE: MARY T LUEBBERT RD, LMNT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	498	NE
2	133V00000X	Registered Dietitian	811273	NE

General Provider Information

NPI Number	:	1174665871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY T LUEBBERT RD, LMNT

Provider Business Mailing Address
First Line	:	1600 S 48TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-1299
Country	:	US
Telephone Number	:	402-481-6305
Fax Number	:	402-481-6338

Provider Business Practice Location Address
First Line	:	1600 S 48TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-1299
Country	:	US
Telephone Number	:	402-481-8195
Fax Number	:	402-481-6338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/14/2025

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