Healthcare Provider Details

I. General information

NPI: 1104465285
Provider Name (Legal Business Name): DANIEL BUZZELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ORONDO AVE STE 1
WENATCHEE WA
98801-2800
US

IV. Provider business mailing address

PO BOX 613
CHELAN WA
98816-0613
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-6000
  • Fax:
Mailing address:
  • Phone: 919-797-5297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61012546
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: