Provider Demographics
NPI:1063098879
Name:HUBBARD, CARLA MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MICHELLE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 HINKSON ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-6228
Mailing Address - Country:US
Mailing Address - Phone:610-998-5735
Mailing Address - Fax:
Practice Address - Street 1:733 HINKSON ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-6228
Practice Address - Country:US
Practice Address - Phone:610-998-5735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN310261164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse