Healthcare Provider Details

I. General information

NPI: 1487735890
Provider Name (Legal Business Name): KATHERINE ELIZABETH LUEBKE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W HAMLET AVE
HAMLET NC
28345-4522
US

IV. Provider business mailing address

PO BOX 1227
HAMLET NC
28345-1227
US

V. Phone/Fax

Practice location:
  • Phone: 910-205-0400
  • Fax: 910-205-7796
Mailing address:
  • Phone: 910-205-7775
  • Fax: 910-205-7796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number186647
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: