Provider Demographics
NPI:1205209541
Name:LUBIC, MARA IRENE (LPN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:IRENE
Last Name:LUBIC
Suffix:
Gender:F
Credentials:LPN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 LOOKOUT CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-6306
Mailing Address - Country:US
Mailing Address - Phone:912-604-1938
Mailing Address - Fax:757-401-6206
Practice Address - Street 1:1517 LOOKOUT CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-6306
Practice Address - Country:US
Practice Address - Phone:912-604-1938
Practice Address - Fax:757-401-6206
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCL-86497174N00000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN