Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP015383 | PA |
NPI | 1083084040 |
---|---|
Provider Name | Maureen Lubas |
First Address | Media, PA 19063-5139 |
Second Address | Media, PA 19063-5139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2015 |
Last Update Date | 03/10/2015 |