Provider Demographics
NPI:1306804075
Name:NEIBURGER, LORELEI J (NP)
Entity type:Individual
Prefix:MS
First Name:LORELEI
Middle Name:J
Last Name:NEIBURGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORELEI
Other - Middle Name:J
Other - Last Name:KACZMARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5055 E BROADWAY BLVD STE A-100
Mailing Address - Street 2:ARIZONA COMMUNITY PHYSICIANS PC
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:5555 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2415
Practice Address - Country:US
Practice Address - Phone:520-721-7886
Practice Address - Fax:520-290-0596
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ049451363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ880436Medicaid