Provider Demographics
NPI:1346667482
Name:BUBAK, CAROL L (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:BUBAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 REEVE DR W
Mailing Address - Street 2:UNIT #18
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1476
Mailing Address - Country:US
Mailing Address - Phone:610-250-8864
Mailing Address - Fax:
Practice Address - Street 1:2045 WESTGATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7480
Practice Address - Country:US
Practice Address - Phone:724-838-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN254630L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse