Provider Demographics
NPI:1376561811
Name:VANBUREN, NANCY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LEE
Last Name:VANBUREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:737 PELHAM BLVD
Mailing Address - Street 2:INNOVATIVE BLOOD RESOURCES
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1739
Mailing Address - Country:US
Mailing Address - Phone:651-332-7272
Mailing Address - Fax:651-332-7022
Practice Address - Street 1:1875 WOODWINDS DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2298
Practice Address - Country:US
Practice Address - Phone:651-264-1500
Practice Address - Fax:651-264-1646
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN29007207ZP0102X, 207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN099565700Medicaid
MN013957200Medicaid
MN191813300Medicaid
MN191813300Medicaid
MN099565700Medicaid
220000947Medicare ID - Type UnspecifiedINDIV UPP
690610930Medicare ID - Type UnspecifiedGROUP CRPL