Provider Demographics
NPI:1720281918
Name:RUBLEE, NANCY JEAN (RDH, CDHC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:RUBLEE
Suffix:
Gender:F
Credentials:RDH, CDHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N 16399 HELBERG ROAD
Mailing Address - Street 2:
Mailing Address - City:BUTTERNUT
Mailing Address - State:WI
Mailing Address - Zip Code:54514
Mailing Address - Country:US
Mailing Address - Phone:715-762-1842
Mailing Address - Fax:
Practice Address - Street 1:104 S EYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-1342
Practice Address - Country:US
Practice Address - Phone:715-339-5311
Practice Address - Fax:715-339-3057
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001772-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33809400Medicaid