Provider Demographics
NPI:1700819885
Name:HUBBARD, KATHLEEN B (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:B
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1115
Mailing Address - Country:US
Mailing Address - Phone:570-558-6372
Mailing Address - Fax:570-558-9471
Practice Address - Street 1:423 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1115
Practice Address - Country:US
Practice Address - Phone:570-558-6372
Practice Address - Fax:570-558-9471
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA228840L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025186MOJMedicare ID - Type Unspecified
PA025186QW6Medicare PIN