Provider Demographics
NPI:1962049379
Name:HUBBARD, JENNIE (LPN)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:
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:JENNIE HUBBARD
Mailing Address - Street 2:269 CEMETERY ROAD
Mailing Address - City:HAVERHILL
Mailing Address - State:NH
Mailing Address - Zip Code:03765-9998
Mailing Address - Country:US
Mailing Address - Phone:603-289-6478
Mailing Address - Fax:
Practice Address - Street 1:574 N PLEASANT ST UNIT 2
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-8713
Practice Address - Country:US
Practice Address - Phone:802-505-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH017816-22164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse