Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00853200 | NJ |
NPI | 1063996650 |
---|---|
Provider Name | Meredith Claire Lubas |
First Address | Fair Lawn, NJ 07410-3016 |
Second Address | Fair Lawn, NJ 07410-3016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2018 |
Last Update Date | 21/01/2019 |