Marisa Bruzzone, LMP

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA00021645 Issued in WA

Practice address

11417 124TH Ave NE Ste 104
Kirkland, WA 98033-4677

Phone

(206) 734-6566

Fax

(206) 275-4876

NPI assigned

Nov 2, 2010

Last updated

Jan 21, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1750681193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14210 79TH AVE NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980340712",
            "telephone_number": "206-734-6566",
            "fax_number": "206-905-2994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11417 124TH AVE NE STE 104",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980334677",
            "telephone_number": "206-734-6566",
            "fax_number": "206-275-4876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUZZONE",
        "first_name": "MARISA",
        "name_prefix": "Ms.",
        "credential": "LMP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-02",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA00021645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rose Ann Buckingham, DNP, RN
• Jacqueline Renee Buckley, DPM

• Specialist in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.