Provider Demographics
NPI:1780484212
Name:HUBBARD, MATTHEW (NTP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2833
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-2833
Mailing Address - Country:US
Mailing Address - Phone:907-500-8415
Mailing Address - Fax:907-500-8415
Practice Address - Street 1:232 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-4400
Practice Address - Country:US
Practice Address - Phone:907-500-8415
Practice Address - Fax:907-500-8415
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2210787133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist