Provider Demographics
NPI:1801071147
Name:HUBER, KATHRYN IDA (RN)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:IDA
Last Name:HUBER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-2916
Mailing Address - Country:US
Mailing Address - Phone:724-452-7564
Mailing Address - Fax:
Practice Address - Street 1:204 PIONEER DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-2916
Practice Address - Country:US
Practice Address - Phone:724-452-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN289542L163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice