Provider Demographics
NPI:1053324590
Name:HUBBARD, JUDY J (RN)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:J
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:JANDREY
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3208 SE 152ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5137
Mailing Address - Country:US
Mailing Address - Phone:360-892-6455
Mailing Address - Fax:
Practice Address - Street 1:3208 SE 152ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5137
Practice Address - Country:US
Practice Address - Phone:360-892-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR099056Medicaid