Provider Demographics
NPI:1710193701
Name:BUETTNER, LYNETTE JEANNE
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:JEANNE
Last Name:BUETTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:ENOCHS
Other - Last Name:BUETTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:322 WEST BEALL ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3463
Mailing Address - Country:US
Mailing Address - Phone:406-586-5390
Mailing Address - Fax:406-587-8429
Practice Address - Street 1:324 WEST BEALL ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-586-5390
Practice Address - Fax:406-587-8429
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5601453Medicaid
MT30930OtherBCBS OF MT
MT30930OtherBCBS OF MT