Healthcare Provider Details

I. General information

NPI: 1780484212
Provider Name (Legal Business Name): MATTHEW HUBBARD NTP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 FIFTH AVE
SEWARD AK
99664-4400
US

IV. Provider business mailing address

PO BOX 2833
SEWARD AK
99664-2833
US

V. Phone/Fax

Practice location:
  • Phone: 907-500-8415
  • Fax: 907-500-8415
Mailing address:
  • Phone: 907-500-8415
  • Fax: 907-500-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2210787
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: