Individual
COURTNEY L HUBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1500 W 22ND ST STE 301, SIOUX FALLS, SD 57105-1503
(605) 328-7700
(605) 328-7775
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1243
SD
363AM0700X
Medical Physician Assistant
5601008846
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1243
PHYSICIAN ASSISTANT LICENSE
SD
01
—
5601008846
PHYSICIAN'S ASSISTANT LICENSE
MI
Enumeration date
12/06/2018
Last updated
10/01/2020
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