Provider Demographics
NPI:1447880687
Name:HUBBARD, DIANA (ND)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 NW SOUTH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WAUKOMIS
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1439
Mailing Address - Country:US
Mailing Address - Phone:770-605-4985
Mailing Address - Fax:
Practice Address - Street 1:1810 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2109
Practice Address - Country:US
Practice Address - Phone:770-605-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21-00058175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath