Healthcare Provider Details

I. General information

NPI: 1013415348
Provider Name (Legal Business Name): PATRICIA GERHARDT BUZELLI AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

296 MERIDIAN ST APT 1
BOSTON MA
02128-1693
US

V. Phone/Fax

Practice location:
  • Phone: 857-238-1000
  • Fax:
Mailing address:
  • Phone: 425-635-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2330163
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: