Healthcare Provider Details

I. General information

NPI: 1528067667
Provider Name (Legal Business Name): TAMI BUZZARD ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MAIN ST
OLEAN NY
14760-1513
US

IV. Provider business mailing address

535 MAIN ST
OLEAN NY
14760-1513
US

V. Phone/Fax

Practice location:
  • Phone: 716-376-2237
  • Fax: 716-376-2239
Mailing address:
  • Phone: 716-376-2237
  • Fax: 716-376-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: