Healthcare Provider Details

I. General information

NPI: 1386636801
Provider Name (Legal Business Name): NANCY L. BUELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE SUITE 205
DU BOIS PA
15801-1462
US

IV. Provider business mailing address

PO BOX 447
DU BOIS PA
15801-0447
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-0373
  • Fax: 814-371-0359
Mailing address:
  • Phone: 814-371-0373
  • Fax: 814-371-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA002436L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: