Healthcare Provider Details

I. General information

NPI: 1245483205
Provider Name (Legal Business Name): NICOLE MARIE BUEHLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARIE LANDIN

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 CHICAGO AVE
MINNEAPOLIS MN
55407
US

IV. Provider business mailing address

8170 33RD AVE MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 612-313-0000
  • Fax: 612-313-0004
Mailing address:
  • Phone: 612-313-0000
  • Fax: 612-313-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11628
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: