Provider Demographics
NPI:1629461520
Name:LUBBERS, VICKI (CNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:LUBBERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W GLYNN DR
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-9605
Mailing Address - Country:US
Mailing Address - Phone:605-928-3311
Mailing Address - Fax:605-928-7368
Practice Address - Street 1:401 W GLYNN DR
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366-9605
Practice Address - Country:US
Practice Address - Phone:605-928-3311
Practice Address - Fax:605-928-7368
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily