Individual
CHARISH LANE HUBBARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1143 W 150 N, SPRINGVILLE, UT 84663-5558
(208) 339-2952
Mailing address
1143 W 150 N, SPRINGVILLE, UT 84663-5558
(208) 339-2952
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
42059
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
12373948-8901
UT
Other
Enumeration date
05/05/2021
Last updated
09/14/2021
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