Provider Demographics
NPI:1326672858
Name:BUFKIN, LAREA
Entity Type:Individual
Prefix:MS
First Name:LAREA
Middle Name:
Last Name:BUFKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 S MASON MONTGOMERY RD # 1085
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9759
Mailing Address - Country:US
Mailing Address - Phone:248-915-0628
Mailing Address - Fax:
Practice Address - Street 1:9550 S MASON MONTGOMERY RD # 1085
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9759
Practice Address - Country:US
Practice Address - Phone:248-915-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide