Provider Demographics
NPI:1972324804
Name:HUBBARD, JAMIE LEE (ILC, PPD)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LEE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:ILC, PPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70442 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-9136
Mailing Address - Country:US
Mailing Address - Phone:269-359-6578
Mailing Address - Fax:
Practice Address - Street 1:70442 6TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-9136
Practice Address - Country:US
Practice Address - Phone:269-359-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula