Healthcare Provider Details

I. General information

NPI: 1568815017
Provider Name (Legal Business Name): PATRICIA BUZZELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 GRAND AVE SUITE 2
DELTA CO
81416-2000
US

IV. Provider business mailing address

115 GRAND AVE SUITE 2
DELTA CO
81416-2000
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-0464
  • Fax: 970-874-0464
Mailing address:
  • Phone: 970-874-0464
  • Fax: 970-874-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0074249
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: