Provider Demographics
NPI:1104911585
Name:HUBER, JOY (FNP)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WILSON STREET
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-5016
Mailing Address - Country:US
Mailing Address - Phone:406-233-2600
Mailing Address - Fax:406-233-2763
Practice Address - Street 1:2600 WILSON STREET
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-5016
Practice Address - Country:US
Practice Address - Phone:406-233-2600
Practice Address - Fax:406-233-2763
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0439673Medicaid
MT14726OtherSTATE LIC NUMBER
MT000374720OtherBCBS PROVIDER NUMBER
MTP72339Medicare UPIN
MT000374720OtherBCBS PROVIDER NUMBER