Healthcare Provider Details

I. General information

NPI: 1346581949
Provider Name (Legal Business Name): DEMETRIA BUCKNER BS HEALTH SCIENCES,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 WALSHAM WAY
INDIANAPOLIS IN
46254-2327
US

IV. Provider business mailing address

3250 A WEST 86TH ST #1289
INDIANAPOLIS IN
46268-3605
US

V. Phone/Fax

Practice location:
  • Phone: 317-509-7674
  • Fax:
Mailing address:
  • Phone: 317-567-1293
  • Fax: 317-981-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: