Healthcare Provider Details

I. General information

NPI: 1023008158
Provider Name (Legal Business Name): TARA ANN BUSSETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 W CHESTER PIKE STE 350
HAVERTOWN PA
19083-2738
US

IV. Provider business mailing address

2010 W CHESTER PIKE STE 350
HAVERTOWN PA
19083-2738
US

V. Phone/Fax

Practice location:
  • Phone: 610-853-1112
  • Fax: 610-446-1425
Mailing address:
  • Phone: 610-853-1112
  • Fax: 610-446-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberUP006453G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: