Provider Demographics
NPI:1588675649
Name:HUBERTY, CONNIE (APN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HUBERTY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4891 INDEPENDENCE STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6713
Mailing Address - Country:US
Mailing Address - Phone:303-456-5495
Mailing Address - Fax:303-456-7490
Practice Address - Street 1:5265 VANCE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3714
Practice Address - Country:US
Practice Address - Phone:303-232-3366
Practice Address - Fax:303-232-8734
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209-005736363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25191Medicare ID - Type UnspecifiedLOCAL 15