Provider Demographics
NPI:1174820245
Name:LUBEGA, HANATI TARWRISA
Entity Type:Individual
Prefix:MS
First Name:HANATI
Middle Name:TARWRISA
Last Name:LUBEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:HANATI
Other - Middle Name:TARWRISA
Other - Last Name:LUBEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:12 INGALLS CT
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3712
Mailing Address - Country:US
Mailing Address - Phone:978-996-9698
Mailing Address - Fax:
Practice Address - Street 1:12 INGALLS CT
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3712
Practice Address - Country:US
Practice Address - Phone:978-996-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN265499363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology