Healthcare Provider Details

I. General information

NPI: 1114317419
Provider Name (Legal Business Name): DONNA BUECHNER NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S 8TH ST
SHEBOYGAN WI
53081-4404
US

IV. Provider business mailing address

PO BOX 959
SHEBOYGAN WI
53082-0959
US

V. Phone/Fax

Practice location:
  • Phone: 920-783-6633
  • Fax: 262-654-9333
Mailing address:
  • Phone: 920-783-6633
  • Fax: 262-654-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6194-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: