Provider Demographics
NPI:1316228265
Name:JUBERG, LARISSA A (CNM)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:A
Last Name:JUBERG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5228
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:5419 N LOVINGTON HWY STE 29
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9136
Practice Address - Country:US
Practice Address - Phone:575-392-0077
Practice Address - Fax:575-392-3925
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM628176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM628OtherCNM