Ivette Lubicich, RN
Individual provider Active NPI Registered Nurse · Shoreheam, NY
NPI 1689350506 · NPPES record last updated Jun 26, 2023
Key facts
- NPI
- 1689350506
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 803251 (NY)
- Practice address
- 47 Cobblestone Drive
Shoreheam, NY 11786 - Phone
- (516) 743-0385
- NPI assigned
- Jun 26, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 803251 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 803251 | NY | Yes |
Addresses
Primary practice location
47 Cobblestone Drive
Shoreheam, NY 11786
Mailing address
47 Cobblestone Drive
Shoreheam, NY 11786
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.