Healthcare Provider Details

I. General information

NPI: 1275738460
Provider Name (Legal Business Name): CORINE R BUECHNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 SE 13TH ST
GRAND RAPIDS MN
55744-4257
US

IV. Provider business mailing address

3920 13TH AVE E SUITE 6
HIBBING MN
55746-3675
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-9100
  • Fax: 218-326-9200
Mailing address:
  • Phone: 218-263-7540
  • Fax: 866-732-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR905040
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: