Healthcare Provider Details

I. General information

NPI: 1770906497
Provider Name (Legal Business Name): MARTHA BUECHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HURON ST
CHICAGO IL
60611-3197
US

IV. Provider business mailing address

6851 HUNTINGTON HILLS BLVD
LAKELAND FL
33810-5379
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3627
  • Fax:
Mailing address:
  • Phone: 478-957-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209011216
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: