Provider Demographics
NPI:1275741399
Name:HUBBARD, ELIZABETH S (RN)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:S
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2507
Mailing Address - Country:US
Mailing Address - Phone:937-643-9823
Mailing Address - Fax:937-643-9823
Practice Address - Street 1:3817 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2507
Practice Address - Country:US
Practice Address - Phone:937-643-9823
Practice Address - Fax:937-643-9823
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH231468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2193022Medicaid