Healthcare Provider Details

I. General information

NPI: 1922202555
Provider Name (Legal Business Name): LETICIA BUEHL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 S THREE NOTCH ST
ANDALUSIA AL
36420-5325
US

IV. Provider business mailing address

849 S THREE NOTCH ST
ANDALUSIA AL
36420-5325
US

V. Phone/Fax

Practice location:
  • Phone: 334-222-8466
  • Fax:
Mailing address:
  • Phone: 334-222-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105050
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA743
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: