Basic Information
| Provider Information | |||||||||
| NPI: | 1912198425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUBBARD | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RN, CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDINA OB/GYN ASSOCIATES | ||||||||
| Address2: | 970 E WASHINGTON ST STE 6B | ||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442569680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307236060 | ||||||||
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| Practice Location | |||||||||
| Address1: | MEDINA OB/GYN ASSOCIATES | ||||||||
| Address2: | 970 E WASHINGTON ST STE 6B | ||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442569680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307236060 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 08/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 09275 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 2127362 | 05 | OH | MEDICAID |