Provider Demographics
NPI:1336391671
Name:CUBOL, EMMANUEL C (BSN,RN)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:C
Last Name:CUBOL
Suffix:
Gender:M
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5991 PAGENT LN
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2149
Mailing Address - Country:US
Mailing Address - Phone:937-829-3179
Mailing Address - Fax:
Practice Address - Street 1:5991 PAGENT LN
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2149
Practice Address - Country:US
Practice Address - Phone:937-829-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH325236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse