Provider Demographics
NPI:1760255608
Name:BUCHNER, JENICA
Entity Type:Individual
Prefix:
First Name:JENICA
Middle Name:
Last Name:BUCHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11955 STOUT AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-9573
Mailing Address - Country:US
Mailing Address - Phone:616-696-5643
Mailing Address - Fax:
Practice Address - Street 1:11955 STOUT AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-9573
Practice Address - Country:US
Practice Address - Phone:616-696-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer