Provider Demographics
NPI:1851863948
Name:LUBOLD, NATALEE
Entity Type:Individual
Prefix:MS
First Name:NATALEE
Middle Name:
Last Name:LUBOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 SW CENTRAL TER
Mailing Address - Street 2:
Mailing Address - City:FORT WHITE
Mailing Address - State:FL
Mailing Address - Zip Code:32038-4667
Mailing Address - Country:US
Mailing Address - Phone:386-269-2755
Mailing Address - Fax:
Practice Address - Street 1:1189 NW SOPHIE DR
Practice Address - Street 2:
Practice Address - City:WHITE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32096-7430
Practice Address - Country:US
Practice Address - Phone:386-269-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-30
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health