Provider Demographics
NPI:1770740334
Name:LUBY, CANDIA KATHLEEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:CANDIA
Middle Name:KATHLEEN
Last Name:LUBY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:12301 SNOW ROAD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44133
Mailing Address - Country:US
Mailing Address - Phone:216-265-4432
Mailing Address - Fax:216-265-4478
Practice Address - Street 1:12301 SNOW ROAD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44133
Practice Address - Country:US
Practice Address - Phone:216-265-4432
Practice Address - Fax:216-265-4478
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH149131163WM0705X
OH09976363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical