Provider Demographics
NPI:1295008662
Name:VANBUREN, PATRICIA JEAN (RN)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JEAN
Last Name:VANBUREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6010 JUNG ROAD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:53956
Mailing Address - Country:US
Mailing Address - Phone:920-326-5789
Mailing Address - Fax:
Practice Address - Street 1:N6010 JUNG RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:WI
Practice Address - Zip Code:53956-9706
Practice Address - Country:US
Practice Address - Phone:920-326-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178336-030163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice