Provider Demographics
NPI:1528699758
Name:BUENO WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:BUENO WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUENO
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:432-614-9298
Mailing Address - Street 1:511 W 8TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4406
Mailing Address - Country:US
Mailing Address - Phone:432-614-9298
Mailing Address - Fax:432-614-9357
Practice Address - Street 1:511 W 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4406
Practice Address - Country:US
Practice Address - Phone:432-614-9298
Practice Address - Fax:432-614-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18686903Medicaid