Individual
BETHANY LISI BUIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
MEDICAL CENTER BVLD, WINSTON SALEM, NC 27157-1247
(336) 716-3636
(336) 713-7314
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-3636
(336) 713-7314
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0010-03594
NC
363A00000X
Physician Assistant
Primary
0010-03594
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8102584
—
NC
Enumeration date
07/17/2012
Last updated
10/31/2024
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