Provider Demographics
NPI:1932389905
Name:BUZARD, MARY J (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:BUZARD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MOFFIT AVE
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-1418
Mailing Address - Country:US
Mailing Address - Phone:814-837-8309
Mailing Address - Fax:814-837-8309
Practice Address - Street 1:319 MOFFIT AVE
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-1418
Practice Address - Country:US
Practice Address - Phone:814-837-8309
Practice Address - Fax:814-837-8309
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN272919L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018884290004Medicaid