Healthcare Provider Details

I. General information

NPI: 1285320887
Provider Name (Legal Business Name): KIMBERLY BUZZELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 MANOR DR
EBENSBURG PA
15931-4917
US

IV. Provider business mailing address

93 OLD MILL RD
CREEKSIDE PA
15732-8319
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-6060
  • Fax: 814-472-1293
Mailing address:
  • Phone: 724-680-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: