Healthcare Provider Details

I. General information

NPI: 1306683685
Provider Name (Legal Business Name): DIONA NICOLE BUETTNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N WOLFE ST
BALTIMORE MD
21205-2110
US

IV. Provider business mailing address

10205 CAMPBELL BLVD
MIDDLE RIVER MD
21220-1853
US

V. Phone/Fax

Practice location:
  • Phone: 845-222-4397
  • Fax:
Mailing address:
  • Phone: 845-222-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR217127
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: