MEDICARE: AMY MARIE LUEBEHUSEN CRNP

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	363LF0000X	Family Nurse Practitioner	R172676	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP3319	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1518930593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARIE LUEBEHUSEN CRNP

Provider Business Mailing Address
First Line	:	13 OAK KNOLL RD
Second Line	:
City	:	COCKEYSVILLE
State	:	MD
Zip	:	21030-2322
Country	:	US
Telephone Number	:	410-961-6578
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 S EXETER ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4316
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	02/16/2024

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