Provider Demographics
NPI:1902043243
Name:HUBBARD, RITA CELESTINE (LPN BA MED)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:CELESTINE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LPN BA MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7503 RUGBY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2607
Mailing Address - Country:US
Mailing Address - Phone:267-408-6417
Mailing Address - Fax:215-924-1103
Practice Address - Street 1:7503 RUGBY ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-2607
Practice Address - Country:US
Practice Address - Phone:267-408-6417
Practice Address - Fax:215-924-1103
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN084112L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse