Healthcare Provider Details

I. General information

NPI: 1043490857
Provider Name (Legal Business Name): JULIE MARIE BUFORD WHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 WEST MAIN STREET SUITE E
FREDERICKTOWN MO
63645-1111
US

IV. Provider business mailing address

611 WEST MAIN STREET SUITE E
FREDERICKTOWN MO
63645-1111
US

V. Phone/Fax

Practice location:
  • Phone: 573-783-3341
  • Fax: 573-783-1024
Mailing address:
  • Phone: 573-783-3341
  • Fax: 573-783-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN147013
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: