Provider Demographics
NPI:1669115762
Name:BUHMEYER, JACQUELYN NOEL (CRNA)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:NOEL
Last Name:BUHMEYER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:NOEL
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1108 S MAIN ST UNIT 223
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3367
Mailing Address - Country:US
Mailing Address - Phone:843-330-6406
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3955
Practice Address - Country:US
Practice Address - Phone:864-255-1183
Practice Address - Fax:864-255-1229
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-16
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC238337163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty