Healthcare Provider Details

I. General information

NPI: 1083503353
Provider Name (Legal Business Name): CARI BUCKNER RN CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE VETERANS DRIVE
MINNEAPOLIS MN
55417
US

IV. Provider business mailing address

1006 FIELD CT
HAMEL MN
55340-3100
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-1340
  • Fax:
Mailing address:
  • Phone: 612-964-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR1348525
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: