MEDICARE: JENIFER BLAXALL BUICE LCCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula
2	174H00000X	Health Educator

General Provider Information

NPI Number	:	1396068136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER BLAXALL BUICE LCCE

Provider Business Mailing Address
First Line	:	123 FORT GREENE PL APT 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3490
Country	:	US
Telephone Number	:	917-543-4736
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 FORT GREENE PL APT 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3490
Country	:	US
Telephone Number	:	917-543-4736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	10/17/2022

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