Provider Demographics
NPI:1679383574
Name:HUBBELL, STEPHEN ROSS JR (RN, LMT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROSS
Last Name:HUBBELL
Suffix:JR
Gender:M
Credentials:RN, LMT
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:15214 SW MILLIKAN WAY APT 726
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-6616
Mailing Address - Country:US
Mailing Address - Phone:928-963-1690
Mailing Address - Fax:
Practice Address - Street 1:15214 SW MILLIKAN WAY APT 726
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-6616
Practice Address - Country:US
Practice Address - Phone:928-963-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR10017676163W00000X
OR25776225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist