Provider Demographics
NPI:1588620967
Name:MCNALL-LUBECK, MABEL CADELINIA (NP-C,MSN)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:CADELINIA
Last Name:MCNALL-LUBECK
Suffix:
Gender:F
Credentials:NP-C,MSN
Other - Prefix:
Other - First Name:M.
Other - Middle Name:CHRIS
Other - Last Name:MCNALL-LUBECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C,MSN
Mailing Address - Street 1:751 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:CARDIOLOGY DEPARTMENT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331647363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN331647Medicaid
CARN331647Medicaid
CAR21899Medicare UPIN