Healthcare Provider Details

I. General information

NPI: 1679895213
Provider Name (Legal Business Name): VANESSA BUETTNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4981 GOLDEN GATE PKWY
NAPLES FL
34116-6972
US

IV. Provider business mailing address

4981 GOLDEN GATE PKWY
NAPLES FL
34116-6972
US

V. Phone/Fax

Practice location:
  • Phone: 239-455-4181
  • Fax: 239-455-3896
Mailing address:
  • Phone: 239-455-4181
  • Fax: 239-455-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA44035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: