Healthcare Provider Details

I. General information

NPI: 1245576362
Provider Name (Legal Business Name): CAROLYN HUBBELL R. N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 W AIRLINE HWY
LA PLACE LA
70068-3336
US

IV. Provider business mailing address

1809 W AIRLINE HWY
LA PLACE LA
70068-3336
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-8444
  • Fax: 985-652-2450
Mailing address:
  • Phone: 985-652-8444
  • Fax: 985-652-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN034042
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: