Provider Demographics
NPI:1184842916
Name:BUICE, BERYL A (RN, NCC)
Entity Type:Individual
Prefix:
First Name:BERYL
Middle Name:A
Last Name:BUICE
Suffix:
Gender:F
Credentials:RN, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 STOLTENBERG RD
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-8302
Mailing Address - Country:US
Mailing Address - Phone:715-445-2328
Mailing Address - Fax:
Practice Address - Street 1:931 STOLTENBERG RD
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-8302
Practice Address - Country:US
Practice Address - Phone:715-445-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management