MEDICARE: ELSA CAMPOS BUCIO FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024178537	VA
2	363LF0000X	Family Nurse Practitioner	5014738	NC

General Provider Information

NPI Number	:	1053940882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSA CAMPOS BUCIO FNP-C

Provider Business Mailing Address
First Line	:	439 US HIGHWAY 158 W
Second Line	:
City	:	YANCEYVILLE
State	:	NC
Zip	:	27379-8304
Country	:	US
Telephone Number	:	336-694-9331
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 E MEADOW RD STE 6
Second Line	:
City	:	EDEN
State	:	NC
Zip	:	27288-3469
Country	:	US
Telephone Number	:	363-864-2795
Fax Number	:	336-694-7511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	01/11/2023

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