Provider Demographics
NPI:1770652505
Name:BUITEN, CATHY LORRAINE (NP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:LORRAINE
Last Name:BUITEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36823 THINBARK ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1138
Mailing Address - Country:US
Mailing Address - Phone:734-721-3754
Mailing Address - Fax:
Practice Address - Street 1:36823 THINBARK ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1138
Practice Address - Country:US
Practice Address - Phone:734-721-3754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704188712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4721740Medicaid
MIP34780043Medicare PIN