Provider Demographics
NPI:1982637963
Name:BUBENIK, NANCY E (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:E
Last Name:BUBENIK
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:E
Other - Last Name:HUELSKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 2009B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-5649
Practice Address - Fax:314-251-6918
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO073245363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health