Provider Demographics
NPI:1043563497
Name:HUBERT, LESLIE S (NP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:HUBERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3444
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3444
Mailing Address - Country:US
Mailing Address - Phone:812-471-1591
Mailing Address - Fax:
Practice Address - Street 1:100 ST MARYS EPWORTH XING STE B100
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9161
Practice Address - Country:US
Practice Address - Phone:812-853-9651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006996A363L00000X
IN28201051A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse