Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 122075-30 | WI |
N | 363L00000X | Nurse Practitioner | 122075-30 | WI |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3835-33 | WI |
NPI | 1013148980 |
---|---|
Provider Name | Lisa Hubbard |
First Address | Milwaukee, WI 53226-2315 |
Second Address | Milwaukee, WI 53210-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 04/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013148980 | BLUE CROSS BLUE SHIELD (01) | WI |