Basic Information
| Provider Information | |||||||||
| NPI: | 1568815017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUZZELL | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 GRAND AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814162000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708740464 | ||||||||
| FaxNumber: | 9708740464 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 GRAND AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814162000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708740464 | ||||||||
| FaxNumber: | 9708740464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2016 | ||||||||
| LastUpdateDate: | 07/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0074249 | CO | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | RN.0074249 | 01 | CO | RN LICENSE | OTHER |