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General NPI Number Information
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NPI Number | 1215925862
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Entity Type | Individual
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Provider Name | KATHLEEN BUONOMO CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 2010 OLD WEST CHESTER PIKE SUITE 330
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City | HAVERTOWN
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State | PA
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Zip | 19083-2712
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Country | US
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Telephone | 610-789-8070
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Fax | 610-789-9937
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Provider Business Mailing Address
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Address Line | 333 N OXFORD VALLEY RD STE 510
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City | FAIRLESS HILLS
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State | PA
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Zip | 19030-2629
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Country | US
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Telephone | 215-785-0145
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Fax | 215-785-0161
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN246195L
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License Number State | PA
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