MRS. DEBRA BUBACK (NPI# 1154305076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154305076 |
| Entity Type | Individual |
| Full Name | MRS. DEBRA BUBACK |
| Credential | RN, MSN, ANP |
| Practice Address |
12855 N 40 Dr Suite 375 Saint Louis MO 63141-8635 |
| Practice Telephone | 3145676071 |
| Practice Fax Number | 3145677961 |
| Mailing Telephone | 3145676071 |
| Mailing Fax Number | 3145677961 |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2008-02-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SM0705X |
Clinical Nurse Specialist Specialization: Medical-Surgical |
063206 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | BLUE CROSS BLUE SHIELD | 154193 | 01 |
| Street Address |
12855 N 40 DR SUITE 375 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-8635 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942206354 | St. Louis Pharmaceutical Services LLC | Pharmacy | 12855 N 40 Dr, Saint Louis, MO 63141-8635 | 2005-06-22 |
| 1700423076 | Faisal Matar | Nurse Practitioner | 12855 N 40 Dr, Saint Louis, MO 63141-8622 | 2019-12-05 |
| 1750847984 | Samantha Mintert | Nurse Practitioner | 12855 N 40 Dr, Saint Louis, MO 63141-8622 | 2019-02-12 |
| 1629439302 | Elizabeth Galler | Physician Assistant | 12855 N 40 Dr, 180, Saint Louis, MO 63141-8657 | 2016-03-09 |
| 1992161210 | Amy Thayer | Nurse Practitioner | 12855 N 40 Dr, Suite 180, Saint Louis, MO 63141-8657 | 2016-01-04 |
| 1821453796 | Mason Ridge Ambulatory Surgery Center Lp | Clinic/Center | 12855 N 40 Dr, Suite 150, Saint Louis, MO 63141-8657 | 2015-12-21 |
| 1083090088 | Rebecca Suzanne Roe Thomasson | Physician Assistant | 12855 N 40 Dr, Suite 180, Saint Louis, MO 63141-8657 | 2015-08-03 |
| 1891179040 | Forefront Dermatology, S.c. | Dermatology | 12855 N 40 Dr, Suite 180, Saint Louis, MO 63141 | 2015-07-17 |
| 1669869657 | Christopher Joseph Forsbach | Podiatrist | 12855 N 40 Dr, Saint Louis, MO 63141 | 2015-04-17 |
| 1346633930 | Chesterfield Anesthesia Associates of Missouri, LLC | Anesthesiology | 12855 N 40 Dr, 150, Saint Louis, MO 63141-8657 | 2015-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 364SM0705X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Medical-Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588088009 | Loren Suzanne Vandergriff | Clinical Nurse Specialist | 2325 Dougherty Ferry Rd, Suite 100, Saint Louis, MO 63122-3356 | 2014-02-05 |
| 1679769459 | Mary Ellen Swatske | Clinical Nurse Specialist | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2007-09-14 |
| 1578637153 | Janet M Ludwig | Clinical Nurse Specialist | 1201 S Grand Blvd, Saint Louis, MO 63104-1016 | 2006-11-17 |
| 1669546396 | Mary Katherine Dorsey | Clinical Nurse Specialist | 10012 Kennerly Rd, Suite 305, Saint Louis, MO 63128-2197 | 2006-11-17 |
| 1053426809 | Joan Frances Osterloh | Clinical Nurse Specialist | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2006-08-20 |
| 1033137450 | Michelle Lynn Heffron | Clinical Nurse Specialist | 11155 Dunn Rd, Saint Louis, MO 63136-6150 | 2006-07-17 |
| 1053389759 | Karen M Gregory | Clinical Nurse Specialist | 3660 Vista Ave, Saint Louis, MO 63110-2540 | 2006-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942397310 | Lavonne M Burrows | Clinical Nurse Specialist | 101 Skaggs Rd Ste 302, Branson, MO 65616-2062 | 2006-10-06 |
| 1174797120 | Marcia Sue Beck | Clinical Nurse Specialist | 2301 Holmes St, Kansas City, MO 64108-2640 | 2008-04-21 |
| 1962620906 | Deborah Summers | Clinical Nurse Specialist | 4401 Wornall Rd, Kansas City, MO 64111-3220 | 2007-04-23 |
| 1700914983 | Paula Ronzio | Clinical Nurse Specialist | 14825 N Outer 40, Suite 200, Chesterfield, MO 63017-2152 | 2007-03-01 |
| 1790855690 | Pamela Ann Golden | Clinical Nurse Specialist | 3635 Vista At Grand, St. Louis, MO 63110-0250 | 2006-11-08 |
| 1457460602 | Vicki L Nower | Clinical Nurse Specialist | 5501 Nw 62nd Ter, Suite #201, Kansas City, MO 64151-2411 | 2006-08-30 |
| 1639116346 | Janice B Dennis | Clinical Nurse Specialist | 4330 Wornall Rd, Suite 2000, Kansas City, MO 64111-5939 | 2006-06-01 |
| 1770543597 | Suzanne Opperman | Clinical Nurse Specialist | 800 Hospital Dr, Columbia, MO 65201-5275 | 2006-03-24 |
| 1871586321 | Andrew L James | Clinical Nurse Specialist | 1 S Keene St, Columbia, MO 65201-7199 | 2005-08-30 |
| 1417940974 | Donna L Smith | Clinical Nurse Specialist | 1 S Keene St, Columbia, MO 65201-7199 | 2005-08-30 |
| Find all providers with the same taxonomy | ||||
| City | SAINT LOUIS |
| Zip Code | 63141 |
Please comment or provide details below to improve the information on MRS. DEBRA BUBACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.