Provider Demographics
NPI:1194822791
Name:KATHLEEN BUXTON
Entity Type:Organization
Organization Name:KATHLEEN BUXTON
Other - Org Name:A WOMAN'S CHOICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-829-8109
Mailing Address - Street 1:1054 GREEN GABLES RD
Mailing Address - Street 2:
Mailing Address - City:EAST GULL LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3167
Mailing Address - Country:US
Mailing Address - Phone:218-829-8109
Mailing Address - Fax:218-829-8109
Practice Address - Street 1:1054 GREEN GABLES RD
Practice Address - Street 2:
Practice Address - City:EAST GULL LAKE
Practice Address - State:MN
Practice Address - Zip Code:56401-3167
Practice Address - Country:US
Practice Address - Phone:218-829-8109
Practice Address - Fax:218-829-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-18
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCFM00458332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1174470001Medicare ID - Type Unspecified