Provider Demographics
NPI:1265129902
Name:BUETTNER, SANDRA K
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:BUETTNER
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 1:36757 BUTTERNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:N RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-8533
Mailing Address - Country:US
Mailing Address - Phone:440-315-2167
Mailing Address - Fax:
Practice Address - Street 1:36757 BUTTERNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:N RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-8533
Practice Address - Country:US
Practice Address - Phone:440-315-2167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider