Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 47004250923 | MI |
NPI | 1063051506 |
---|---|
Provider Name | Tamika Idell Buford |
First Address | Oak Park, MI 48237-2913 |
Second Address | Oak Park, MI 48237-2913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2020 |
Last Update Date | 01/01/2020 |