Provider Demographics
NPI:1245276468
Name:HUBBARD, LOU ANN (CRNP)
Entity type:Individual
Prefix:MS
First Name:LOU
Middle Name:ANN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:GUIN
Mailing Address - State:AL
Mailing Address - Zip Code:35563-0340
Mailing Address - Country:US
Mailing Address - Phone:205-468-3355
Mailing Address - Fax:
Practice Address - Street 1:252 13TH AVE W
Practice Address - Street 2:
Practice Address - City:GUIN
Practice Address - State:AL
Practice Address - Zip Code:35563-2355
Practice Address - Country:US
Practice Address - Phone:205-468-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1029249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051000196OtherBLUE CROSS
AL891008800Medicaid
AL051000196OtherBLUE CROSS
AL891008800Medicaid
ALR35670Medicare UPIN