Healthcare Provider Details

I. General information

NPI: 1255143434
Provider Name (Legal Business Name): MARY C BUERK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S DELMAR AVE
DAYTON OH
45403-2210
US

IV. Provider business mailing address

114 S DELMAR AVE
DAYTON OH
45403-2210
US

V. Phone/Fax

Practice location:
  • Phone: 937-993-3197
  • Fax:
Mailing address:
  • Phone: 937-993-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: