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General NPI Number Information
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NPI Number | 1982336640
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Entity Type | Individual
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Provider Name | MIRANDA LUEBBERT APRN, FNP
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Gender | Female
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1500 SOUTHWEST BLVD STE D
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-2472
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Country | US
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Telephone | 573-632-5780
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Fax | 573-632-5833
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Provider Business Mailing Address
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Address Line | PO BOX 843966
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City | KANSAS CITY
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State | MO
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Zip | 64184-3966
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Country | US
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Telephone | 573-884-3300
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Fax | 573-884-0943
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2022024473
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License Number State | MO
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