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General NPI Number Information
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NPI Number | 1255651097
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Entity Type | Individual
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Provider Name | LUCIA OBERGOENNER WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 112 MAVERICK CT
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City | GRANBURY
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State | TX
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Zip | 76049-1381
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 OLD TOLL RD
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City | JACKSON
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State | MO
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Zip | 63755-3023
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Country | US
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Telephone | 573-979-3892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 2010002440
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 2010002440
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 1172658
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License Number State | TX
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