Provider Demographics
NPI:1083056923
Name:BUFORD, BRENDA L (STNA)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:L
Last Name:BUFORD
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3862 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4430
Mailing Address - Country:US
Mailing Address - Phone:216-269-8683
Mailing Address - Fax:
Practice Address - Street 1:3862 W 135TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4430
Practice Address - Country:US
Practice Address - Phone:216-269-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401187440111374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401187440111OtherSTNA