=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811813363
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY LUBAWY APRN AG-CNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2026
-----------------------------------------------------
Last Update Date | 06/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1106 COLLEGE ST STE C
-----------------------------------------------------
City | BASTROP
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78602-3948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-244-4272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9507 GAMBELS QUAIL DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-6222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-468-7394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364S00000X
-----------------------------------------------------
Taxonomy Name | Clinical Nurse Specialist
-----------------------------------------------------
License Number | 2026057803
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------