Healthcare Provider Details

I. General information

NPI: 1275582322
Provider Name (Legal Business Name): CAROLE E BUCHMILLER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 6 VA MEDICAL CENTER
IOWA CITY IA
52246
US

IV. Provider business mailing address

2726 HICKORY TRL
IOWA CITY IA
52245-3523
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-0581
  • Fax:
Mailing address:
  • Phone: 319-338-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number00021
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: