Provider Demographics
NPI:1225450927
Name:LOU ANN HUBBARD LLC
Entity Type:Organization
Organization Name:LOU ANN HUBBARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-468-3000
Mailing Address - Street 1:252 13TH AVE W
Mailing Address - Street 2:
Mailing Address - City:GUIN
Mailing Address - State:AL
Mailing Address - Zip Code:35563-2355
Mailing Address - Country:US
Mailing Address - Phone:205-468-3000
Mailing Address - Fax:205-468-3033
Practice Address - Street 1:252 13TH AVE W
Practice Address - Street 2:
Practice Address - City:GUIN
Practice Address - State:AL
Practice Address - Zip Code:35563-2355
Practice Address - Country:US
Practice Address - Phone:205-468-3000
Practice Address - Fax:205-468-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-029249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1245276468OtherINDIVIDUAL NPI