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NPI Code Detail

MEDICARE: SOPHIE ALICE BUBNAR RN

MEDICARE: SOPHIE ALICE BUBNAR RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse4704434571MI

General Provider Information

NPI Number : 1871426973
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIE ALICE BUBNAR RN
Provider Business Mailing Address
First Line : 4255 ISLAND VIEW DR
Second Line :
City : FENTON
State : MI
Zip : 48430-9144
Country : US
Telephone Number : 810-893-0769
Fax Number :
Provider Business Practice Location Address
First Line : 400 N INGALLS ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48109-2003
Country : US
Telephone Number : 734-763-5985
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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Directions to “ SOPHIE ALICE BUBNAR RN” Practice Location

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