Provider Demographics
NPI:1336200310
Name:BUENO, NANCY P (FNP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:P
Last Name:BUENO
Suffix:
Gender:F
Credentials:FNP-C
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 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-614-9298
Mailing Address - Fax:432-614-9357
Practice Address - Street 1:511 W 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4406
Practice Address - Country:US
Practice Address - Phone:432-614-9298
Practice Address - Fax:432-614-9357
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186868903Medicaid
TX8L12726Medicare PIN