Provider Demographics
NPI:1710224159
Name:BUZAN, JENNA LEIGH
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEIGH
Last Name:BUZAN
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 1:3439 SANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-5546
Mailing Address - Country:US
Mailing Address - Phone:580-286-2333
Mailing Address - Fax:
Practice Address - Street 1:3439 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-5546
Practice Address - Country:US
Practice Address - Phone:580-286-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator