Healthcare Provider Details

I. General information

NPI: 1093319402
Provider Name (Legal Business Name): REBECCA BUZZARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 PARRISH LN
ASHFORD WV
25009-9091
US

IV. Provider business mailing address

42 PARRISH LN
ASHFORD WV
25009-9091
US

V. Phone/Fax

Practice location:
  • Phone: 304-836-5505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60251
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: