Provider Demographics
NPI:1356622682
Name:KIEBRE, LUC (RN)
Entity type:Individual
Prefix:
First Name:LUC
Middle Name:
Last Name:KIEBRE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 SHAKER BLVD
Mailing Address - Street 2:APT 205
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2065
Mailing Address - Country:US
Mailing Address - Phone:216-526-9754
Mailing Address - Fax:
Practice Address - Street 1:12600 SHAKER BLVD
Practice Address - Street 2:APT 205
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2065
Practice Address - Country:US
Practice Address - Phone:216-526-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH355927163W00000X, 163WI0500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care