Healthcare Provider Details

I. General information

NPI: 1326419268
Provider Name (Legal Business Name): AMANDA BUKSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W EXCHANGE ST #330
AKRON OH
44302-1704
US

IV. Provider business mailing address

224 W EXCHANGE ST #330
AKRON OH
44302-1704
US

V. Phone/Fax

Practice location:
  • Phone: 330-436-3150
  • Fax:
Mailing address:
  • Phone: 330-436-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA. 18296-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: