Provider Demographics
NPI:1053531483
Name:HUBER, COLLEEN (NMD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E BASELINE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1440
Mailing Address - Country:US
Mailing Address - Phone:480-839-2800
Mailing Address - Fax:480-897-2453
Practice Address - Street 1:1250 E BASELINE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1404
Practice Address - Country:US
Practice Address - Phone:480-839-2800
Practice Address - Fax:480-897-2453
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-948175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath