Provider Demographics
NPI:1205589389
Name:HUBBARD, KATLIN EMILY (FNP-C)
Entity type:Individual
Prefix:
First Name:KATLIN
Middle Name:EMILY
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATLIN
Other - Middle Name:EMILY
Other - Last Name:DE GRASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1033 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2856
Mailing Address - Country:US
Mailing Address - Phone:562-315-3492
Mailing Address - Fax:
Practice Address - Street 1:1033 SOUTH DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2856
Practice Address - Country:US
Practice Address - Phone:562-315-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704334561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily