Healthcare Provider Details

I. General information

NPI: 1750941803
Provider Name (Legal Business Name): JACQUELINE M BUSS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE M HERBERT CRNP

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 QUAKERS WAY
QUAKERTOWN PA
18951-2754
US

IV. Provider business mailing address

519 S 5TH ST STE 130
PERKASIE PA
18944-1061
US

V. Phone/Fax

Practice location:
  • Phone: 215-536-0655
  • Fax:
Mailing address:
  • Phone: 215-257-8601
  • Fax: 215-257-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP018465
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: