Provider Demographics
NPI:1013935998
Name:BUETTNER, NEIL W JR (CRNA)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:W
Last Name:BUETTNER
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000 DEPT 931
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-382-1200
Mailing Address - Fax:901-382-8070
Practice Address - Street 1:1995 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3635
Practice Address - Country:US
Practice Address - Phone:901-382-1200
Practice Address - Fax:901-382-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN92955367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430062458OtherRR MEDICARE
TN4288522OtherBLUE SHIELD TN
TN12857OtherTLC
TN173758OtherBETTER HEALTH
TN2041149OtherUHC
TN3621368Medicaid
MS05629011OtherMEDICAID
TN3621368Medicare ID - Type UnspecifiedMEDICARE
TN3621368Medicaid