Individual
MRS. DEBRA BUBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, ANP
Contact information
Practice address
12855 N 40 DR, SUITE 375, SAINT LOUIS, MO 63141-8635
(314) 567-6071
(314) 567-7961
Mailing address
12855 N 40 DR, SUITE 375, SAINT LOUIS, MO 63141-8635
(314) 567-6071
(314) 567-7961
Taxonomy
Speciality
Code
Description
License number
State
364SM0705X
Medical-Surgical Clinical Nurse Specialist
Primary
063206
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154193
BLUE CROSS BLUE SHIELD
MO
Enumeration date
12/05/2005
Last updated
02/08/2008
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