Healthcare Provider Details

I. General information

NPI: 1336169143
Provider Name (Legal Business Name): MARCIA BUZYNISKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WASHINGTON ST
WATERTOWN NY
13601-4066
US

IV. Provider business mailing address

PO BOX 596
WATERTOWN NY
13601-0596
US

V. Phone/Fax

Practice location:
  • Phone: 315-785-8509
  • Fax: 315-785-8619
Mailing address:
  • Phone: 315-782-4207
  • Fax: 315-782-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number405145
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: