Healthcare Provider Details

I. General information

NPI: 1811482391
Provider Name (Legal Business Name): LESLIE ANNE BUBLICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WALNUT ST
WATERTOWN MA
02472-4054
US

IV. Provider business mailing address

101 WALNUT ST
WATERTOWN MA
02472-4054
US

V. Phone/Fax

Practice location:
  • Phone: 888-897-1887
  • Fax:
Mailing address:
  • Phone: 888-897-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032692
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2296034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: