Provider Demographics
NPI:1649730151
Name:BUECHELE, JACKIE LYNN (LPN)
Entity type:Individual
Prefix:
First Name:JACKIE LYNN
Middle Name:
Last Name:BUECHELE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12409 LORAIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3515
Mailing Address - Country:US
Mailing Address - Phone:216-252-6670
Mailing Address - Fax:
Practice Address - Street 1:12409 LORAIN AVE STE B
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3515
Practice Address - Country:US
Practice Address - Phone:216-252-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN093337L164W00000X
OHLPN.131543.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse