Healthcare Provider Details

I. General information

NPI: 1154666725
Provider Name (Legal Business Name): MADISON HALEY BUCK DNP. DOCTOR OF NURSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADISON HALEY ZUBRISKI

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 11/21/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 E. BALTIMORE PIKE OPTUM SERVE-LH1
MEDIA PA
19063
US

IV. Provider business mailing address

1430 DEKALB ST
NORRISTOWN PA
19401-3406
US

V. Phone/Fax

Practice location:
  • Phone: 484-444-2834
  • Fax: 484-444-2592
Mailing address:
  • Phone: 610-278-5117
  • Fax: 610-278-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN638577
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: