Healthcare Provider Details

I. General information

NPI: 1306934716
Provider Name (Legal Business Name): NANCY JANE HUBBELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SEYMOUR AVE
ST MICHAELS MD
21663-2930
US

IV. Provider business mailing address

24519 NEW POST RD
ST MICHAELS MD
21663-2306
US

V. Phone/Fax

Practice location:
  • Phone: 410-745-2882
  • Fax:
Mailing address:
  • Phone: 410-745-4314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR100335
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: