Provider Demographics
NPI:1669418661
Name:HUEBNER, MICHELE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HUEBNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5184 TEX OAK AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7822
Mailing Address - Country:US
Mailing Address - Phone:214-590-6310
Mailing Address - Fax:
Practice Address - Street 1:5184 TEX OAK AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7822
Practice Address - Country:US
Practice Address - Phone:214-590-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17216363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA17216AMedicare ID - Type Unspecified