Provider Demographics
NPI:1902432180
Name:LUBBE, SHELLY MARIE
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:LUBBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N 7TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2779
Mailing Address - Country:US
Mailing Address - Phone:602-277-6181
Mailing Address - Fax:602-263-9528
Practice Address - Street 1:6003 E FLEMING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-8105
Practice Address - Country:US
Practice Address - Phone:775-846-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV823665363L00000X
AZ231901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner