Provider Demographics
NPI:1104011162
Name:BUBEL, ALICE MARGARET (RN, CASAC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:MARGARET
Last Name:BUBEL
Suffix:
Gender:F
Credentials:RN, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3284 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14423-1228
Mailing Address - Country:US
Mailing Address - Phone:585-538-9887
Mailing Address - Fax:
Practice Address - Street 1:422 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1023
Practice Address - Country:US
Practice Address - Phone:585-786-8133
Practice Address - Fax:585-786-9928
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3580931163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02200358093Medicaid