Healthcare Provider Details

I. General information

NPI: 1366783896
Provider Name (Legal Business Name): ANDREA JEAN BUHL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W POYTHRESS ST
HOPEWELL VA
23860-2532
US

IV. Provider business mailing address

2601 FOUNDERS BRIDGE RD
MIDLOTHIAN VA
23113-6391
US

V. Phone/Fax

Practice location:
  • Phone: 804-458-8557
  • Fax:
Mailing address:
  • Phone: 804-822-6897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024170692
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: