Provider Demographics
NPI:1427391937
Name:HUBER, DAVID WALTER (LPN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WALTER
Last Name:HUBER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 CANANDAIGUA RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-9305
Mailing Address - Country:US
Mailing Address - Phone:585-309-9996
Mailing Address - Fax:
Practice Address - Street 1:1111 CANANDAIGUA RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522-9305
Practice Address - Country:US
Practice Address - Phone:585-309-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310233164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse