Healthcare Provider Details

I. General information

NPI: 1912232232
Provider Name (Legal Business Name): JENNIFER JEAN BUECHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2009
Last Update Date: 10/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 G ST APT C ROYAL GARDENS 25-3
TAMUNING GU
96913-3771
US

IV. Provider business mailing address

US NAVAL HOSPITAL GUAM FARENHOLT AVENUE BUILDING 1
AGANA HEIGHTS GUAM
96919
UM

V. Phone/Fax

Practice location:
  • Phone: 671-482-1029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number18256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number2984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: