Healthcare Provider Details

I. General information

NPI: 1023374162
Provider Name (Legal Business Name): JENNIFER L WHEELER BUENGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L WHEELER

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC 10 5590 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1114 BELLA SPRINGS VW APT 116
COLORADO SPRINGS CO
80921-5602
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3053
  • Fax: 505-925-0546
Mailing address:
  • Phone: 303-503-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number50091
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: