Provider Demographics
NPI:1417630856
Name:LUBBEN, MEGAN ELAINE (PA)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELAINE
Last Name:LUBBEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ELAINE
Other - Last Name:BOYANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 NW ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3562
Mailing Address - Country:US
Mailing Address - Phone:931-455-2273
Mailing Address - Fax:
Practice Address - Street 1:711 NW ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3562
Practice Address - Country:US
Practice Address - Phone:931-455-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant