Provider Demographics
NPI:1821406364
Name:UBBEN, MICHELLE LEANN (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEANN
Last Name:UBBEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEAN
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3915
Mailing Address - Country:US
Mailing Address - Phone:515-576-6500
Mailing Address - Fax:515-576-1951
Practice Address - Street 1:126 N 10TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3915
Practice Address - Country:US
Practice Address - Phone:515-576-6500
Practice Address - Fax:515-576-1951
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA103469363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner