Healthcare Provider Details

I. General information

NPI: 1174084875
Provider Name (Legal Business Name): JENNIFER NICOLE BUFFARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 45011
APO AP
96343
JP

IV. Provider business mailing address

UNIT 45011
APO AP
96343
JP

V. Phone/Fax

Practice location:
  • Phone: 315-263-4128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95074974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: