Provider Demographics
NPI:1609833250
Name:BUXTON, LANCE JOSEPH (NP)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:JOSEPH
Last Name:BUXTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0009
Mailing Address - Country:US
Mailing Address - Phone:208-459-1025
Mailing Address - Fax:208-459-1080
Practice Address - Street 1:2005 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4808
Practice Address - Country:US
Practice Address - Phone:208-459-1025
Practice Address - Fax:208-459-1080
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681333363LF0000X
IDNP-648A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y4032OtherBCBS PVN
IDQ22511Medicare UPIN
TX8K2605Medicare PIN