Provider Demographics
NPI:1053308106
Name:HUBBARD, SHARON M (CRNA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:642 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-9672
Practice Address - Country:US
Practice Address - Phone:812-723-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003872367500000X
IN28101953A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2783438000OtherPASSPORT ADVANTAGE
KY000000283663OtherBLUE SHIELD
IN200515430Medicaid
KY50012803OtherPASSPORT
KY7100110280Medicaid
IN163460034OtherMEDICARE
430079779OtherRAILROAD MEDICARE
KYK026130Medicare Oscar/Certification
KY50012803OtherPASSPORT