Provider Demographics
NPI:1528612405
Name:PRAGLE, LIUBA (NP)
Entity type:Individual
Prefix:
First Name:LIUBA
Middle Name:
Last Name:PRAGLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1602
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1602
Mailing Address - Country:US
Mailing Address - Phone:240-362-7025
Mailing Address - Fax:240-362-7571
Practice Address - Street 1:921 SETON DR STE FANDG
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1852
Practice Address - Country:US
Practice Address - Phone:240-522-0098
Practice Address - Fax:240-522-0099
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF11180797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417460619OtherTYPE 2 NPI GROUP #
MDDL77OtherCAREFIRST
MD999023200Medicaid