Provider Demographics
NPI:1457650624
Name:HUBBARD, TANYA L
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:L
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8435 US ROUTE 127
Mailing Address - Street 2:
Mailing Address - City:WEST MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45382-9742
Mailing Address - Country:US
Mailing Address - Phone:937-678-5507
Mailing Address - Fax:
Practice Address - Street 1:8435 US ROUTE 127
Practice Address - Street 2:
Practice Address - City:WEST MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45382-9742
Practice Address - Country:US
Practice Address - Phone:937-678-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN295127163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse