Healthcare Provider Details

I. General information

NPI: 1154955821
Provider Name (Legal Business Name): JENNIFER M BUCHNER ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 FULTON ST W STE B
GRAND RAPIDS MI
49504-5312
US

IV. Provider business mailing address

638 FULTON ST W STE B
GRAND RAPIDS MI
49504-5312
US

V. Phone/Fax

Practice location:
  • Phone: 616-264-6556
  • Fax: 616-432-3564
Mailing address:
  • Phone: 616-264-6556
  • Fax: 616-432-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2020-01
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: