Provider Demographics
NPI:1861374621
Name:BUXTON, ALCYON
Entity type:Individual
Prefix:
First Name:ALCYON
Middle Name:
Last Name:BUXTON
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 1:3241 WILLO DR
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-9595
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3241 WILLO DR
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-9595
Practice Address - Country:US
Practice Address - Phone:616-309-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704368767163WG0000X, 163WC3500X, 163WH0200X
372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WH0200XNursing Service ProvidersRegistered NurseHome Health