Provider Demographics
NPI:1275729642
Name:LUBKEMANN, MICHELLE HUTT (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HUTT
Last Name:LUBKEMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 DEERFIELD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5009
Mailing Address - Country:US
Mailing Address - Phone:828-262-0100
Mailing Address - Fax:828-264-7592
Practice Address - Street 1:345 DEERFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5009
Practice Address - Country:US
Practice Address - Phone:828-262-0100
Practice Address - Fax:828-264-7592
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101640363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101640OtherNC MEDICAL BOARD LICENSE
NC101640OtherNC MEDICAL BOARD LICENSE