Basic Information
| Provider Information | |||||||||
| NPI: | 1942476239 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUEBBE | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 67250 | ||||||||
| Address2: | APT. #204 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685067250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023282907 | ||||||||
| FaxNumber: | 8889650959 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 S 14TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685025336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024793292 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 2271 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.