Provider Demographics
NPI:1528364684
Name:BUETTNER, NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:BUETTNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W. 42ND STREET
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845
Mailing Address - Country:US
Mailing Address - Phone:308-865-2303
Mailing Address - Fax:308-865-2304
Practice Address - Street 1:412 W. 42ND STREET
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845
Practice Address - Country:US
Practice Address - Phone:308-865-2303
Practice Address - Fax:308-865-2304
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1556OtherSTATE OF NEBRASKA