Provider Demographics
NPI:1669905642
Name:BUENAVENTURA, MARIA DOLORES (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
Last Name:BUENAVENTURA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 FINN ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-4204
Mailing Address - Country:US
Mailing Address - Phone:314-456-3417
Mailing Address - Fax:
Practice Address - Street 1:6209 FINN ROCK CIR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-4204
Practice Address - Country:US
Practice Address - Phone:314-456-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017006106363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner