Individual
CARRIE MICHAEL BUBENZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
PO BOX 8500 LOCKBOX 7642, PHILADELPHIA, PA 19178-5682
(318) 226-3300
(318) 424-7610
Mailing address
8731 PARK PLAZA DR, SHREVEPORT, LA 71105-5682
(318) 797-5848
(318) 797-5844
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200579
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12513166
CAQH
—
05
—
2483854
—
LA
Enumeration date
09/18/2012
Last updated
08/16/2024
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