Provider Demographics
NPI:1871651562
Name:HUGHES, JUANITA L
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:L
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2583
Mailing Address - Country:US
Mailing Address - Phone:320-763-9661
Mailing Address - Fax:320-763-9661
Practice Address - Street 1:1116 BROADWAY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2583
Practice Address - Country:US
Practice Address - Phone:320-763-9661
Practice Address - Fax:320-763-9661
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7G259PJOtherBCBS MN
MN030701168OtherPRIMEWEST
MN366025700Medicaid
MN7G259PJOtherBCBS MN