Healthcare Provider Details

I. General information

NPI: 1154464659
Provider Name (Legal Business Name): EFFIE MAE BUCKLEY R.N., M.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7174 SANTA TERESA BLVD A-6
SAN JOSE CA
95139-1350
US

IV. Provider business mailing address

7174 SANTA TERESA BLVD. A-6
SAN JOSE CA
95139-1135
US

V. Phone/Fax

Practice location:
  • Phone: 408-363-1498
  • Fax: 408-363-1599
Mailing address:
  • Phone: 408-363-1498
  • Fax: 408-363-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN265730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: