Healthcare Provider Details

I. General information

NPI: 1285369017
Provider Name (Legal Business Name): LINDSAY NICOLE BUELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2022
Last Update Date: 07/16/2022
Certification Date: 07/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 JEFFERSON ST
SHELTON WA
98584-2004
US

IV. Provider business mailing address

507 WOODDUCK DR SW
OLYMPIA WA
98502-2673
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-8401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61327001
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: