Provider Demographics
NPI:1114502549
Name:LUBAHN, CHRISTINE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LUBAHN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 6TH ST SW
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1284
Mailing Address - Country:US
Mailing Address - Phone:507-218-6493
Mailing Address - Fax:
Practice Address - Street 1:303 6TH ST SW
Practice Address - Street 2:
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-1284
Practice Address - Country:US
Practice Address - Phone:507-218-6493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1107307253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency