Healthcare Provider Details

I. General information

NPI: 1962816165
Provider Name (Legal Business Name): MARINELA BUZAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4613 NE WORK AVE
VANCOUVER WA
98663-2159
US

IV. Provider business mailing address

4613 NE WORK AVE
VANCOUVER WA
98663-2159
US

V. Phone/Fax

Practice location:
  • Phone: 360-314-5448
  • Fax: 360-993-7734
Mailing address:
  • Phone: 360-314-5448
  • Fax: 360-993-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60448928
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: