Healthcare Provider Details

I. General information

NPI: 1306129226
Provider Name (Legal Business Name): SUSAN A. BUZZANCO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2281 EAST RD
ERIE PA
16509-5769
US

IV. Provider business mailing address

2281 EAST RD
ERIE PA
16509-5769
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6481
  • Fax: 814-455-9440
Mailing address:
  • Phone: 814-877-6481
  • Fax: 814-455-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN293739L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: