MEDICARE: MRS. LYUBOV LYNN SPEEGLE PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1685	OK
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1265610471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYUBOV LYNN SPEEGLE PAC

Provider Business Mailing Address
First Line	:	10100 MILLSPAUGH WAY
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-7975
Country	:	US
Telephone Number	:	405-615-1178
Fax Number	:

Provider Business Practice Location Address
First Line	:	4107 N COUNCIL RD
Second Line	:
City	:	BETHANY
State	:	OK
Zip	:	73008-3131
Country	:	US
Telephone Number	:	405-889-6366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	12/12/2024

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