Provider Demographics
NPI:1518660810
Name:HUBBARD, ELIZABETH CANDACE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CANDACE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 W HIGHWAY 66 APT 1610
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-0020
Mailing Address - Country:US
Mailing Address - Phone:240-271-4021
Mailing Address - Fax:
Practice Address - Street 1:7800 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4948
Practice Address - Country:US
Practice Address - Phone:405-495-8606
Practice Address - Fax:405-495-4356
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2275133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered