Provider Demographics
NPI:1548040827
Name:BUIE, STEPHANIE R (OWNER/DIRECTOR)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:R
Last Name:BUIE
Suffix:
Gender:F
Credentials:OWNER/DIRECTOR
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:BUIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1802 MARTIN LUTHER KING PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3586
Mailing Address - Country:US
Mailing Address - Phone:919-451-9185
Mailing Address - Fax:
Practice Address - Street 1:1802 MARTIN LUTHER KING PKWY STE 108406
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3586
Practice Address - Country:US
Practice Address - Phone:919-451-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC7164253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care