Healthcare Provider Details

I. General information

NPI: 1699843672
Provider Name (Legal Business Name): ELSIE ALICE BUEHLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 LINCOLN WAY STE A
CLINTON IA
52732-7203
US

IV. Provider business mailing address

2635 LINCOLN WAY STE A
CLINTON IA
52732-7203
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-1413
  • Fax: 563-242-9992
Mailing address:
  • Phone: 563-243-1413
  • Fax: 563-242-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF115781
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: