MEDICARE: LISA 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	:	1346791092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HUBBARD

Provider Business Mailing Address
First Line	:	13870 E RIVER VISTA CIR
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-5601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10355 E PALMER WASILLA HWY
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-8876
Country	:	US
Telephone Number	:	907-746-3418
Fax Number	:

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

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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Directions to “ LISA HUBBARD ” Practice Location

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