Healthcare Provider Details

I. General information

NPI: 1376159095
Provider Name (Legal Business Name): JONI MARIE BUZZELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21280 BONANZA BLVD
ELKHORN NE
68022-1803
US

IV. Provider business mailing address

21280 BONANZA BLVD
ELKHORN NE
68022-1803
US

V. Phone/Fax

Practice location:
  • Phone: 402-968-4465
  • Fax:
Mailing address:
  • Phone: 402-968-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number55282
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: