Provider Demographics
NPI:1750845194
Name:BUOL, JENNIFER (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BUOL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-4057
Mailing Address - Country:US
Mailing Address - Phone:402-239-9436
Mailing Address - Fax:
Practice Address - Street 1:501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FRIEND
Practice Address - State:NE
Practice Address - Zip Code:68359-1349
Practice Address - Country:US
Practice Address - Phone:402-947-2781
Practice Address - Fax:402-947-2951
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN.0044039164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse