MEDICARE: MADISON LUEBKE MSN, APRN, FNP

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	APRN.CNP.0035709	OH

General Provider Information

NPI Number	:	1629839030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON LUEBKE MSN, APRN, FNP

Provider Business Mailing Address
First Line	:	3524 ASCOT CT
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-4401
Country	:	US
Telephone Number	:	567-712-9935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2066 W MAIN ST STE 150
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-2882
Country	:	US
Telephone Number	:	937-376-9731
Fax Number	:

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

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	03/04/2024

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