Healthcare Provider Details

I. General information

NPI: 1215207477
Provider Name (Legal Business Name): KATHERINE SAUTER BUCKLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5786 BUFFALO RD CHURCHVILLE CHII SENIOR HIGH SCHOOL
CHURCHVILLE NY
14428-9785
US

IV. Provider business mailing address

5786 BUFFALO ROAD CHURCHVILLE CHILI SENIOR HIGH SCHOOL
CHURCHVILLE NY
14428-9785
US

V. Phone/Fax

Practice location:
  • Phone: 585-293-1800
  • Fax: 585-293-4508
Mailing address:
  • Phone: 585-293-1800
  • Fax: 585-293-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number351623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: