Provider Demographics
NPI:1275072415
Name:HUBER, MARK W (APRN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:HUBER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10706 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3654
Mailing Address - Country:US
Mailing Address - Phone:402-290-8147
Mailing Address - Fax:
Practice Address - Street 1:655 MONTGOMERY ST STE 810
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2677
Practice Address - Country:US
Practice Address - Phone:844-847-8216
Practice Address - Fax:415-520-9150
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE112182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner