Healthcare Provider Details

I. General information

NPI: 1821591991
Provider Name (Legal Business Name): ALICIA ROBERTA BUECHE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S WILLIAM ST
SOUTH BEND IN
46601-2515
US

IV. Provider business mailing address

5639 E 350 N
ROLLING PRAIRIE IN
46371-9594
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-2870
  • Fax:
Mailing address:
  • Phone: 574-520-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28207642A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008073A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: