Healthcare Provider Details

I. General information

NPI: 1699858472
Provider Name (Legal Business Name): MARY SUSAN BUFFINGTON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 WINTERHAVEN DRIVE
WINTERHAVEN CA
92283
US

IV. Provider business mailing address

1166 K ST
BRAWLEY CA
92227-2737
US

V. Phone/Fax

Practice location:
  • Phone: 760-572-2700
  • Fax:
Mailing address:
  • Phone: 760-344-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN083233
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: