Individual
MARY B. LUBERDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
143 ACREVIEW DR, DE PERE, WI 54115-3655
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075288
CERTIFIED SURGICAL TECHNOLOGIST
—
Enumeration date
03/24/2010
Last updated
03/24/2010
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