Healthcare Provider Details

I. General information

NPI: 1508663014
Provider Name (Legal Business Name): MICHAELA MARIE HUBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 COVINGTON ST
YOUNGSTOWN OH
44510-1617
US

IV. Provider business mailing address

1001 COVINGTON ST
YOUNGSTOWN OH
44510-1617
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-3258
  • Fax: 330-480-4119
Mailing address:
  • Phone: 330-480-3258
  • Fax: 330-480-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0039023
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: