Provider Demographics
NPI:1710988142
Name:BUCHHEIT, SANDRA R (FNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:BUCHHEIT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1207 E MAIN ST
Mailing Address - Street 2:APT 36
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1596
Mailing Address - Country:US
Mailing Address - Phone:573-803-2400
Mailing Address - Fax:573-803-2404
Practice Address - Street 1:2907 KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1724
Practice Address - Country:US
Practice Address - Phone:573-803-2400
Practice Address - Fax:573-803-2404
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MORN074771363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S80102Medicare UPIN
MO000081138Medicare ID - Type Unspecified