Individual
ANNEX LUBERISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ND
Contact information
Practice address
1674 S ODELL AVE # B, MARSHALL, MO 65340-3365
(660) 229-0858
Mailing address
1674 S ODELL AVE # B, MARSHALL, MO 65340-3365
(660) 229-0858
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710320643
NPI
—
01
—
MA4558
PTAN
—
Enumeration date
11/04/2013
Last updated
11/04/2013
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