Healthcare Provider Details

I. General information

NPI: 1972645208
Provider Name (Legal Business Name): PATRICIA ANNE HUBLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28010 ROAD T APT E
DOLORES CO
81323-8201
US

IV. Provider business mailing address

28010 ROAD T APT E
DOLORES CO
81323-8201
US

V. Phone/Fax

Practice location:
  • Phone: 970-882-2694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number904739
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: