Healthcare Provider Details

I. General information

NPI: 1023401999
Provider Name (Legal Business Name): MARIE ANN LUBACK-NEVES DNP, MBA, APRN, FNP-
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 06/25/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COUNTRY ESTATES CIR STE 1
RENO NV
89511-4016
US

IV. Provider business mailing address

3243 GYPSUM RD
RENO NV
89503-1202
US

V. Phone/Fax

Practice location:
  • Phone: 775-339-3056
  • Fax:
Mailing address:
  • Phone: 775-339-3056
  • Fax: 888-494-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN20727
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number823273
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number823273
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: