MEDICARE: JESSICA HUBBARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1174730477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HUBBARD

Provider Business Mailing Address
First Line	:	1403 SPRING ST # 200
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3736
Country	:	US
Telephone Number	:	812-288-2706
Fax Number	:	812-288-1474

Provider Business Practice Location Address
First Line	:	1403 SPRING ST # 200
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3736
Country	:	US
Telephone Number	:	812-288-2706
Fax Number	:	812-288-1474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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