Provider Demographics
NPI:1790755031
Name:BUHL, JEANI G (FNP)
Entity Type:Individual
Prefix:MS
First Name:JEANI
Middle Name:G
Last Name:BUHL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 PRIM ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520
Mailing Address - Country:US
Mailing Address - Phone:541-488-4588
Mailing Address - Fax:
Practice Address - Street 1:2860 CREEKSIDE CIR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-779-8367
Practice Address - Fax:541-779-7471
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250075NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005591002OtherREGENCE BLUE CROSS
OR000847Medicaid
P78813Medicare UPIN
114787Medicare ID - Type Unspecified