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NPI Code Detail

MEDICARE: CHEYENNE BUZZARD RN

MEDICARE: CHEYENNE BUZZARD RN
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
1163W00000XRegistered Nurse125387WV

General Provider Information

NPI Number : 1992638662
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHEYENNE BUZZARD RN
Provider Business Mailing Address
First Line : 814 CREST DR
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-1102
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 TRACY WAY STE 100
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-1280
Country : US
Telephone Number : 304-720-0205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2026
Last Update Date : 06/04/2026

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Directions to “ CHEYENNE BUZZARD RN” Practice Location

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