Provider Demographics
NPI:1154666725
Name:BUCK, MADISON HALEY (DNP DOCTOR OF NURSI)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:HALEY
Last Name:BUCK
Suffix:
Gender:F
Credentials:DNP DOCTOR OF NURSI
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:HALEY
Other - Last Name:ZUBRISKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3406
Mailing Address - Country:US
Mailing Address - Phone:610-278-5117
Mailing Address - Fax:610-278-5167
Practice Address - Street 1:602 E. BALTIMORE PIKE OPTUM SERVE-LH1
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:484-444-2834
Practice Address - Fax:484-444-2592
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN638577163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000072290052Medicaid