Healthcare Provider Details

I. General information

NPI: 1104354513
Provider Name (Legal Business Name): BONNIE JEAN BUZZARD LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 LANCASTER DR
LAWRENCE KS
66049-1877
US

IV. Provider business mailing address

2412 LANCASTER DR
LAWRENCE KS
66049-1877
US

V. Phone/Fax

Practice location:
  • Phone: 785-727-8985
  • Fax:
Mailing address:
  • Phone: 785-727-8985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number37108
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: