Healthcare Provider Details

I. General information

NPI: 1538627286
Provider Name (Legal Business Name): AMBER MARIE BUECKERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 MAIN ST S STE 106
SAUK CENTRE MN
56378-1780
US

IV. Provider business mailing address

965 MAIN ST S STE 106
SAUK CENTRE MN
56378-1780
US

V. Phone/Fax

Practice location:
  • Phone: 320-293-0376
  • Fax:
Mailing address:
  • Phone: 320-293-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: