Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 71007159A | IN |
N | 363LA2200X | Nurse Practitioner - Adult Health | 71007159A | IN |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 71007159A | IN |
NPI | 1073044954 |
---|---|
Provider Name | Ms. Caitlin Elizabeth Luebcke |
First Address | Greenwood, IN 46143-1072 |
Second Address | Greenwood, IN 46143-1072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 14/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300006642 | (05) | IN |