Basic Information
| Provider Information | |||||||||
| NPI: | 1982799136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUZARD | ||||||||
| FirstName: | CORINA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C, RD, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 EAST GREEN ST | ||||||||
| Address2: | |||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278931850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522439800 | ||||||||
| FaxNumber: | 2522439888 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 GREEN ST E | ||||||||
| Address2: | |||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278934105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522439800 | ||||||||
| FaxNumber: | 2522439888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | L001768 | NC | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 363A00000X | NC102594 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.