Provider Demographics
NPI:1780710806
Name:LUBECK, NORMA ADRIENNE (DO)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:ADRIENNE
Last Name:LUBECK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 30TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7365
Mailing Address - Country:US
Mailing Address - Phone:425-392-2147
Mailing Address - Fax:425-392-8197
Practice Address - Street 1:1709 30TH AVE NE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-7365
Practice Address - Country:US
Practice Address - Phone:425-392-2147
Practice Address - Fax:425-392-8197
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP 00001615207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA135355OtherL&I NUMBER
WA1111129OtherDSHS NUMBER
WAAB14728Medicare ID - Type UnspecifiedPIERCE COUNTY
WAAB14729Medicare ID - Type UnspecifiedKING COUNTY
WAH12660Medicare UPIN