Provider Demographics
NPI:1700105178
Name:MAIRE, BUENACARMEN GETUBIG
Entity Type:Individual
Prefix:MRS
First Name:BUENACARMEN
Middle Name:GETUBIG
Last Name:MAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 BLUEBELLE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7430
Mailing Address - Country:US
Mailing Address - Phone:541-726-8478
Mailing Address - Fax:
Practice Address - Street 1:7065 BLUEBELLE WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-7430
Practice Address - Country:US
Practice Address - Phone:541-726-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200530113LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse