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: 09/29/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 CHESTNUT ST
PHILADELPHIA PA
19107-4140
US

IV. Provider business mailing address

545 N BROAD ST STE 703
PHILADELPHIA PA
19123-3597
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 Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN758712
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: