Provider Demographics
NPI:1255651097
Name:OBERGOENNER, LUCIA (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LUCIA
Middle Name:
Last Name:OBERGOENNER
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-7708
Mailing Address - Country:US
Mailing Address - Phone:573-334-2516
Mailing Address - Fax:
Practice Address - Street 1:1111 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7708
Practice Address - Country:US
Practice Address - Phone:573-334-2516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010002440363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health