Provider Demographics
NPI:1275579062
Name:BUVID, MARSHA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:LYNN
Last Name:BUVID
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 POINT CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:WI
Mailing Address - Zip Code:53063
Mailing Address - Country:US
Mailing Address - Phone:920-726-4367
Mailing Address - Fax:
Practice Address - Street 1:8304 POINT CREEK ROAD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:WI
Practice Address - Zip Code:53063
Practice Address - Country:US
Practice Address - Phone:920-726-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22581031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38287100Medicaid