Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 0024179471 | VA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 0024179471 | VA |
NPI | 1073288379 |
---|---|
Provider Name | Chantel Renee Buffalow |
First Address | Newport News, VA 23602-4460 |
Second Address | Newport News, VA 23602-4460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2021 |
Last Update Date | 10/08/2021 |