Provider Demographics
NPI:1386636801
Name:BUELL, NANCY L (PA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:BUELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-371-0373
Mailing Address - Fax:814-371-0359
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-371-0373
Practice Address - Fax:814-371-0359
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002436L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP20082Medicare UPIN
PA184416Medicare PIN