Provider Demographics
NPI:1477511772
Name:HUBER, JOLENE R (PA-C)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:R
Last Name:HUBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 EAST CAMPUS MALL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1381
Mailing Address - Country:US
Mailing Address - Phone:608-265-5600
Mailing Address - Fax:
Practice Address - Street 1:333 EAST CAMPUS MALL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1381
Practice Address - Country:US
Practice Address - Phone:608-265-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1050-023363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42991600Medicaid
WI60025OtherDEAN HEALTH INSURANCE
WI60025OtherDEAN HEALTH INSURANCE
WI075574150Medicare PIN
S76294Medicare UPIN
WI970025141Medicare PIN