Basic Information
| Provider Information | |||||||||
| NPI: | 1104547017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUISON | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | DEMMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | JOHN D. DINGELL | ||||||||
| Address2: | 4646 JOHN R ST. | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4646 JOHN R ST | ||||||||
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| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482011916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135761714 | ||||||||
| FaxNumber: | 3135761827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2022 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704184555 | MI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.