Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 63045-20 | WI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 63045-20 | WI |
NPI | 1124462205 |
---|---|
Provider Name | Dr. Julia Rose Lubsen |
First Address | Middleton, WI 53562-5531 |
Second Address | Belleville, WI 53508-9433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2013 |
Last Update Date | 15/01/2021 |