Healthcare Provider Details

I. General information

NPI: 1609833250
Provider Name (Legal Business Name): LANCE JOSEPH BUXTON N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 ARLINGTON AVE
CALDWELL ID
83605-4808
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-459-1025
  • Fax: 208-459-1080
Mailing address:
  • Phone: 208-459-1025
  • Fax: 208-459-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number681333
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-648A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: