Healthcare Provider Details

I. General information

NPI: 1710501150
Provider Name (Legal Business Name): MISTY M BUFFENMEYER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 OLD JACKSONVILLE RD STE 110
SPRINGFIELD IL
62704-7401
US

IV. Provider business mailing address

3132 OLD JACKSONVILLE RD STE 110
SPRINGFIELD IL
62704-7401
US

V. Phone/Fax

Practice location:
  • Phone: 217-588-2600
  • Fax: 217-862-0904
Mailing address:
  • Phone: 217-588-2600
  • Fax: 217-862-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021172
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: