Healthcare Provider Details

I. General information

NPI: 1508437203
Provider Name (Legal Business Name): TESSA MARIE BUEHRER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 N ANKENY BLVD STE A
ANKENY IA
50023-4611
US

IV. Provider business mailing address

603 S NORRIS ST
PRAIRIE CITY IA
50228-8516
US

V. Phone/Fax

Practice location:
  • Phone: 515-965-4680
  • Fax:
Mailing address:
  • Phone: 515-249-5209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125154
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24333
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: