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NPI Code Detail

MEDICARE: CHARLENE C LUEBCKE CSFA

MEDICARE: CHARLENE C LUEBCKE CSFA
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
1246ZC0007XSurgical Assistant

General Provider Information

NPI Number : 1982178950
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLENE C LUEBCKE CSFA
Provider Business Mailing Address
First Line : 500 E CENTRAL AVE
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33880-3094
Country : US
Telephone Number : 863-293-1191
Fax Number :
Provider Business Practice Location Address
First Line : 500 E CENTRAL AVE
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33880-3094
Country : US
Telephone Number : 863-293-1191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2019
Last Update Date : 01/14/2019

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