Provider Demographics
NPI:1245871839
Name:LUBINA, PAMELA G
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:LUBINA
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 1:12708 STRIZICH RD
Mailing Address - Street 2:
Mailing Address - City:SIDE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55781-8406
Mailing Address - Country:US
Mailing Address - Phone:218-481-2974
Mailing Address - Fax:
Practice Address - Street 1:12708 STRIZICH RD
Practice Address - Street 2:
Practice Address - City:SIDE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55781-8406
Practice Address - Country:US
Practice Address - Phone:218-481-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health