MEDICARE: ALYSSA LOUISE BUBEL

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	163W00000X	Registered Nurse	RN758712	PA

General Provider Information

NPI Number	:	1316810039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA LOUISE BUBEL

Provider Business Mailing Address
First Line	:	545 N BROAD ST STE 703
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3597
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4140
Country	:	US
Telephone Number	:	215-982-2637
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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Directions to “ ALYSSA LOUISE BUBEL ” Practice Location

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