Healthcare Provider Details

I. General information

NPI: 1699109371
Provider Name (Legal Business Name): NOELLE MARIE BUFFUM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MITCHELL AVENUE
BINGHAMTON NY
13903
US

IV. Provider business mailing address

103 ALLEN ST
JOHNSON CITY NY
13790-2000
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-0639
  • Fax:
Mailing address:
  • Phone: 607-372-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338172-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: