Individual
MARILYN HUBBARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5110 MIDDAY DR, BLACK JACK, MO 63033-8521
(314) 741-9981
(314) 741-9982
Mailing address
5110 MIDDAY DR, BLACK JACK, MO 63033-8521
(314) 741-9981
(314) 741-9982
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000
—
MO
Enumeration date
11/26/2013
Last updated
11/26/2013
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