Provider Demographics
NPI:1285686329
Name:BUCHE, MONICA (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BUCHE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:GENDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-288-1928
Mailing Address - Fax:765-741-0335
Practice Address - Street 1:205 N TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3900
Practice Address - Country:US
Practice Address - Phone:765-288-1995
Practice Address - Fax:765-289-7512
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000205A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71000205AOtherNURSE PRACTITIONER LICENS
IN200295740IMedicaid
IN000000665424OtherANTHEM BC