Healthcare Provider Details

I. General information

NPI: 1316810039
Provider Name (Legal Business Name): ALYSSA LOUISE BUBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 CHESTNUT ST
PHILADELPHIA PA
19107-4140
US

IV. Provider business mailing address

26 SYCAMORE DR
READING PA
19606-9542
US

V. Phone/Fax

Practice location:
  • Phone: 215-982-2637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11051025
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP037166
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: