Provider Demographics
NPI:1609548569
Name:BUFORD, TARREN (LPN)
Entity Type:Individual
Prefix:
First Name:TARREN
Middle Name:
Last Name:BUFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 W 3RD ST STE 111
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1536
Mailing Address - Country:US
Mailing Address - Phone:719-383-3041
Mailing Address - Fax:
Practice Address - Street 1:13 W 3RD ST STE 111
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1591
Practice Address - Country:US
Practice Address - Phone:719-383-3041
Practice Address - Fax:719-383-3060
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48648164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse