Healthcare Provider Details

I. General information

NPI: 1982799136
Provider Name (Legal Business Name): CORINA LEE BUZARD PA-C, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 GREEN ST E
WILSON NC
27893-4105
US

IV. Provider business mailing address

303 GREEN ST E
WILSON NC
27893-4105
US

V. Phone/Fax

Practice location:
  • Phone: 252-243-9800
  • Fax: 252-243-9888
Mailing address:
  • Phone: 252-293-0013
  • Fax: 252-243-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL001768
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102594
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: