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General NPI Number Information
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NPI Number | 1285101030
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Entity Type | Individual
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Provider Name | AAQUILA BUFFINGTON - SHEPARD FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 15990 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4826
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Country | US
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Telephone | 248-849-5692
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Fax |
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Provider Business Mailing Address
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Address Line | 15442 ASHTON RD
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City | DETROIT
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State | MI
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Zip | 48223-1302
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Country | US
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Telephone | 313-622-4915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2018014420
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License Number State | MI
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