Provider Demographics
NPI:1093838963
Name:LUBBERS, LISA ANNETTE (CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNETTE
Last Name:LUBBERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNETTE
Other - Last Name:ROLLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0401
Mailing Address - Country:US
Mailing Address - Phone:605-328-3000
Mailing Address - Fax:605-328-3001
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-328-3000
Practice Address - Fax:605-328-3001
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000374363LN0000X
MNR160724-0363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR 160724-0OtherMN RN
SD4993173OtherWELLMARK
SD6829300Medicaid
SD9254403OtherDAKOTACARE
SDLUB1-0430-2308OtherNCC ID
SDCP000374OtherCNP LICENSE
SDR0287659OtherRN LICENSE