Healthcare Provider Details

I. General information

NPI: 1114282936
Provider Name (Legal Business Name): BENJAMIN BUCHER FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 2ND AVE NE
ROLLA ND
58367-7153
US

IV. Provider business mailing address

213 2ND AVE NE PO BOX 759
ROLLA ND
58367-7153
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-3161
  • Fax: 701-477-5564
Mailing address:
  • Phone: 701-477-3161
  • Fax: 701-477-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR30373
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: