Healthcare Provider Details

I. General information

NPI: 1053660423
Provider Name (Legal Business Name): CHERYL LOU BUECHLER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N7812 RIGHT OF WAY RD
CRIVITZ WI
54114-7661
US

IV. Provider business mailing address

N7812 RIGHT OF WAY RD
CRIVITZ WI
54114-7661
US

V. Phone/Fax

Practice location:
  • Phone: 715-854-2982
  • Fax:
Mailing address:
  • Phone: 715-854-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number315824-31
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: