Sadie Buboltz-Dubs, DAT, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1482-39 Issued in WI

Practice address

2420 Nicolet Dr
Green Bay, WI 54311-7003

Phone

(920) 377-1544

NPI assigned

Jan 16, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588204800000",
    "number": "1083150957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1348 GEORGE ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541153527",
            "telephone_number": "920-377-1544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 NICOLET DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543117003",
            "telephone_number": "920-377-1544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBOLTZ-DUBS",
        "first_name": "SADIE",
        "credential": "DAT, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-16",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "1482-39",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "buboltzs@uwgb.edu",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "N/A",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "N/A",
            "address_1": "2420 Nicolet Dr",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543117003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James A Brusky, DDS
• Bruss Supportive Community Living
• Dianna Leigh Bruss, LPC
• Todd Harold Bruss, ATC, LAT, CSCS, PA-C
• Megan C Brzezinski, APNP
• Aaron H Bubolz, D.O.
• Jamie E Bucher, NP
• Jamee Buck
• Christopher Anthony Buckman, MA
• Benjamin Buckoski, CCP

• Athletic Trainer in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.