Provider Demographics
NPI:1033359005
Name:HUBBARD, MICHAELA J (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:J
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:J
Other - Last Name:BURATCZUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:33 STANIFORD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3105
Mailing Address - Country:US
Mailing Address - Phone:401-649-4992
Mailing Address - Fax:401-273-6510
Practice Address - Street 1:33 STANIFORD ST FL 2
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3105
Practice Address - Country:US
Practice Address - Phone:401-649-4992
Practice Address - Fax:401-273-6510
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN242167367500000X
CT093735367500000X
RIAPRN01764367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered