Provider Demographics
NPI:1467713974
Name:LUBER, JENNIE L (MSOM, LAC)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:L
Last Name:LUBER
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 COUNTY N
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-8410
Mailing Address - Country:US
Mailing Address - Phone:715-360-5708
Mailing Address - Fax:888-817-5972
Practice Address - Street 1:2928 COUNTY N
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8410
Practice Address - Country:US
Practice Address - Phone:715-360-5708
Practice Address - Fax:888-817-5972
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI657-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist