Healthcare Provider Details

I. General information

NPI: 1245293059
Provider Name (Legal Business Name): MICHELE K. BUCKREIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST
ANDERSON SC
29621-1580
US

IV. Provider business mailing address

800 N FANT ST
ANDERSON SC
29621-5708
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-6697
  • Fax:
Mailing address:
  • Phone: 864-512-1417
  • Fax: 864-512-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN 1555
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: