Provider Demographics
NPI:1780318659
Name:HUBER, MICHELLE (AP61329469)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:AP61329469
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1006 S 64TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2090
Mailing Address - Country:US
Mailing Address - Phone:509-902-3625
Mailing Address - Fax:509-676-3415
Practice Address - Street 1:1006 S 64TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2090
Practice Address - Country:US
Practice Address - Phone:509-902-3625
Practice Address - Fax:509-676-3415
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61329469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine