MEDICARE: KATHLEEN LUBBERS

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	100064	MO

General Provider Information

NPI Number	:	1629116637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN LUBBERS

Provider Business Mailing Address
First Line	:	161 WASHINGTON ST
Second Line	:	EIGHT TOWER BRIDGE STE 1400
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2083
Country	:	US
Telephone Number	:	866-825-3227
Fax Number	:	610-862-1547

Provider Business Practice Location Address
First Line	:	3937 VOGEL RD
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-3798
Country	:	US
Telephone Number	:	866-825-3227
Fax Number	:	610-862-1547

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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Directions to “ KATHLEEN LUBBERS ” Practice Location

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