Healthcare Provider Details

I. General information

NPI: 1215279278
Provider Name (Legal Business Name): WERONIKA BUCKNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2013
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HAVANA ST
AURORA CO
80014-1618
US

IV. Provider business mailing address

6068 S KINGSTON CIR
ENGLEWOOD CO
80111-5733
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-3045
  • Fax:
Mailing address:
  • Phone: 810-623-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000182456
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: