Healthcare Provider Details

I. General information

NPI: 1770375487
Provider Name (Legal Business Name): HEIDI G BUETTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 10TH AVE
HOLDREGE NE
68949-1913
US

IV. Provider business mailing address

1326 10TH AVE
HOLDREGE NE
68949-1913
US

V. Phone/Fax

Practice location:
  • Phone: 308-991-9005
  • Fax:
Mailing address:
  • Phone: 308-991-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number155133
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number92996
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: