Healthcare Provider Details

I. General information

NPI: 1790755031
Provider Name (Legal Business Name): JEANI G BUHL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 CREEKSIDE CIR
MEDFORD OR
97504
US

IV. Provider business mailing address

519 PRIM ST
ASHLAND OR
97520
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-8367
  • Fax: 541-779-7471
Mailing address:
  • Phone: 541-488-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200250075NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: