Healthcare Provider Details

I. General information

NPI: 1285272526
Provider Name (Legal Business Name): DANA BUELOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PINEHURST AVE STE 7
SOUTHERN PINES NC
28387-7089
US

IV. Provider business mailing address

615 HERONS BROOK DR
WHISPERING PINES NC
28327-3502
US

V. Phone/Fax

Practice location:
  • Phone: 800-991-6070
  • Fax:
Mailing address:
  • Phone: 816-506-4063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: