Provider Demographics
NPI:1740006964
Name:BUELL, KATRENA ANN
Entity type:Individual
Prefix:
First Name:KATRENA
Middle Name:ANN
Last Name:BUELL
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 1:13825 OLD OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45369-9758
Mailing Address - Country:US
Mailing Address - Phone:326-216-9576
Mailing Address - Fax:
Practice Address - Street 1:13825 OLD OSBORNE RD
Practice Address - Street 2:
Practice Address - City:SOUTH VIENNA
Practice Address - State:OH
Practice Address - Zip Code:45369-9758
Practice Address - Country:US
Practice Address - Phone:326-216-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X, 3747P1801X, 376J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker