Healthcare Provider Details

I. General information

NPI: 1841573672
Provider Name (Legal Business Name): MICHELE LOUISE BUFFORD CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 E PERKINS AVE 1916 EAST PERKINS
GUTHRIE OK
73044-5804
US

IV. Provider business mailing address

PO BOX 1182
GUTHRIE OK
73044-1182
US

V. Phone/Fax

Practice location:
  • Phone: 405-282-8232
  • Fax:
Mailing address:
  • Phone: 405-282-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number21854
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: