Provider Demographics
NPI:1366904625
Name:HUEBNER, MARK WILLIAM
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:HUEBNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 N JEFFERS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3931
Mailing Address - Country:US
Mailing Address - Phone:308-532-7010
Mailing Address - Fax:308-534-8388
Practice Address - Street 1:402 N JEFFERS ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3931
Practice Address - Country:US
Practice Address - Phone:308-532-7010
Practice Address - Fax:308-534-8388
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist