Provider Demographics
NPI:1801890611
Name:HUBER, DEBORAH (ARNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:ARNP
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-223-4823
Mailing Address - Fax:515-223-0482
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:STE 342
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7036
Practice Address - Country:US
Practice Address - Phone:515-223-4823
Practice Address - Fax:515-223-0482
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA075571363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0418830Medicaid
IA0418830Medicaid
IAI1671Medicare ID - Type Unspecified