Provider Demographics
NPI:1306382510
Name:HUBBARD, DAVID M (RN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 LEXVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2915
Mailing Address - Country:US
Mailing Address - Phone:419-756-3774
Mailing Address - Fax:
Practice Address - Street 1:1765 LEXVIEW CIR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2915
Practice Address - Country:US
Practice Address - Phone:419-756-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.383728163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098359Medicaid
OH1972553063OtherBUSINESS NPI
OH367022Medicare UPIN