Healthcare Provider Details

I. General information

NPI: 1467865550
Provider Name (Legal Business Name): JENNIFER SARAH BUESCHER MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E COTATI AVE
ROHNERT PARK CA
94928-3613
US

IV. Provider business mailing address

8001 STARR CT
COTATI CA
94931-5151
US

V. Phone/Fax

Practice location:
  • Phone: 707-843-0652
  • Fax:
Mailing address:
  • Phone: 707-843-0652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number534644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: