Healthcare Provider Details

I. General information

NPI: 1104011162
Provider Name (Legal Business Name): ALICE MARGARET BUBEL RN, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N MAIN ST
WARSAW NY
14569-1023
US

IV. Provider business mailing address

3284 STATE ST
CALEDONIA NY
14423-1228
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-8133
  • Fax: 585-786-9928
Mailing address:
  • Phone: 585-538-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number3580931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: