Healthcare Provider Details

I. General information

NPI: 1023263225
Provider Name (Legal Business Name): KELLY A. BUCCI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 10/30/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W STATE STREET
DOYLESTOWN PA
18901
US

IV. Provider business mailing address

610 W. GERMANTOWN PIKE, SUITE 150
PLYMOUTH MEETING PA
19462
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-2207
  • Fax: 215-829-5567
Mailing address:
  • Phone: 610-525-4966
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN525192L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: