Provider Demographics
NPI:1629839030
Name:LUEBKE, MADISON (MSN, APRN, FNP)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:LUEBKE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:BUTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3524 ASCOT CT
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4401
Mailing Address - Country:US
Mailing Address - Phone:567-712-9935
Mailing Address - Fax:
Practice Address - Street 1:2066 W MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2882
Practice Address - Country:US
Practice Address - Phone:937-376-9731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily