Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036079966 | IL |
NPI | 1023011863 |
---|---|
Provider Name | Mrs. Lucinda S Buescher |
First Address | Springfield, IL 62794-9644 |
Second Address | Springfield, IL 62702-4909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036079966 | (05) | IL |
E46066 | (02) |