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General NPI Number Information
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NPI Number | 1720429566
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Entity Type | Individual
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Provider Name | CAROL BUENTELLO NNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 420 W MAGNETIC ST
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City | MARQUETTE
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State | MI
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Zip | 49855-2700
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Country | US
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Telephone | 906-225-3406
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Fax |
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Provider Business Mailing Address
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Address Line | 374 N NOREN LAKE DR
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City | GWINN
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State | MI
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Zip | 49841-9062
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Country | US
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Telephone | 906-360-6800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 4704222255
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10078
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License Number State | WI
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