Provider Demographics
NPI:1184786774
Name:BUITENWERF, ANITA JOY (NP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:JOY
Last Name:BUITENWERF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M124
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7500
Mailing Address - Fax:269-341-7540
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M124
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7500
Practice Address - Fax:269-341-7540
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704221193363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184786774Medicaid
MI500C961050OtherBCBSM
MI1184786774Medicaid