Healthcare Provider Details

I. General information

NPI: 1053822031
Provider Name (Legal Business Name): ANDREA LAUREN BUERY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA LAUREN BUERY

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 BEAR TRL
NEW BERN NC
28562-9337
US

IV. Provider business mailing address

218 BEAR TRL
NEW BERN NC
28562-9337
US

V. Phone/Fax

Practice location:
  • Phone: 620-506-7722
  • Fax:
Mailing address:
  • Phone: 620-506-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number55055
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: