Provider Demographics
NPI:1982400800
Name:HUBERT, BRYANT
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:HUBERT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BANNER LN NW APT 125
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-6088
Mailing Address - Country:US
Mailing Address - Phone:202-699-5642
Mailing Address - Fax:
Practice Address - Street 1:22 BANNER LN NW APT 125
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-6088
Practice Address - Country:US
Practice Address - Phone:202-699-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant