1811290570 NPI number — DR. MONICA PAIGE BUETTEL PH.D.

Table of content: DR. MONICA PAIGE BUETTEL PH.D. (NPI 1811290570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811290570 NPI number — DR. MONICA PAIGE BUETTEL PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUETTEL
Provider First Name:
MONICA
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811290570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29511 3RD ST
Provider Second Line Business Mailing Address:
PO BOX 741
Provider Business Mailing Address City Name:
SNYDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80750-8005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-396-9523
Provider Business Mailing Address Fax Number:
970-367-1924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 E RAILROAD AVE
Provider Second Line Business Practice Location Address:
SUITE #500
Provider Business Practice Location Address City Name:
FORT MORGAN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80701-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-396-9523
Provider Business Practice Location Address Fax Number:
970-367-1924
Provider Enumeration Date:
12/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  3531 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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