Provider Demographics
NPI:1689963001
Name:BUETTNER, BARBARA CUNNINGHAM (RN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:CUNNINGHAM
Last Name:BUETTNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 NORRIS CANYON RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5405
Mailing Address - Country:US
Mailing Address - Phone:925-327-1500
Mailing Address - Fax:925-327-1900
Practice Address - Street 1:5201 NORRIS CANYON RD STE 310
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5405
Practice Address - Country:US
Practice Address - Phone:925-327-1500
Practice Address - Fax:925-327-1900
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492292363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10991OtherNURSE PRACTITIONER LICENSE#
CA492292OtherREGISTERED NURSE LICENSE