Provider Demographics
NPI:1710501150
Name:BUFFENMEYER, MISTY M (APRN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:M
Last Name:BUFFENMEYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 OLD JACKSONVILLE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7401
Mailing Address - Country:US
Mailing Address - Phone:217-588-2600
Mailing Address - Fax:217-862-0904
Practice Address - Street 1:3132 OLD JACKSONVILLE RD STE 110
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7401
Practice Address - Country:US
Practice Address - Phone:217-588-2600
Practice Address - Fax:217-862-0904
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041370493OtherRN LICENSE