MEDICARE: AAQUILA BUFFINGTON - SHEPARD FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2018014420	MI

General Provider Information

NPI Number	:	1285101030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AAQUILA BUFFINGTON - SHEPARD FNP-BC

Provider Business Mailing Address
First Line	:	15442 ASHTON RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1302
Country	:	US
Telephone Number	:	313-622-4915
Fax Number	:

Provider Business Practice Location Address
First Line	:	15990 W 9 MILE RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-4826
Country	:	US
Telephone Number	:	248-849-5692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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