Provider Demographics
NPI:1356931349
Name:HUBBARD, SARA LOUISE (RN, CDCES)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:LOUISE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 SHOREVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56229-9789
Mailing Address - Country:US
Mailing Address - Phone:507-530-4163
Mailing Address - Fax:
Practice Address - Street 1:300 S BRUCE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1934
Practice Address - Country:US
Practice Address - Phone:507-537-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN154130-6163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator