Doctor Name: | STACYE HOPPER HUBBARD |
NPI Number: | 1710939301 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 37416 |
Business Practice Address: | 40224 Salmon Prairie Rd Swan Lake, MT - 599117877 |
Business Phone Number: | 4067542245 |
Business Fax Number: | 4067542245 |
Mailing Address: | 40224 Salmon Prairie Rd, SWAN LAKE |
State: | MT |
Postal Code: | 599117877 |
Phone Number: | 4067542245 |
Fax Number: | 4067542245 |
NPI Enumeration Date: | 05/16/2006 |
NPI Last Update Date: | 07/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 37416 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |