Provider Demographics
NPI:1275654634
Name:KUBISCH, COLLEEN FRANCES (APRN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:FRANCES
Last Name:KUBISCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-9793
Mailing Address - Country:US
Mailing Address - Phone:413-774-6471
Mailing Address - Fax:
Practice Address - Street 1:489 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2711
Practice Address - Country:US
Practice Address - Phone:413-532-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151470364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA31915OtherHNE
MA2011947OtherCIGNA
MAPN0825OtherBCBS