Provider Demographics
NPI:1225404585
Name:LUBICH, THERESA (LPN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:LUBICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:BIGNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:25935 STATE ROAD 35
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893-8512
Mailing Address - Country:US
Mailing Address - Phone:715-566-2810
Mailing Address - Fax:
Practice Address - Street 1:25935 STATE ROAD 35
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-8512
Practice Address - Country:US
Practice Address - Phone:715-566-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33575-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse