Healthcare Provider Details

I. General information

NPI: 1942993993
Provider Name (Legal Business Name): LAUREN ANNE LUBEJKO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E CHURCH ST STE A
CHERRYVILLE NC
28021-2968
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-445-0422
  • Fax: 704-671-7463
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16755
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: