Healthcare Provider Details

I. General information

NPI: 1558511279
Provider Name (Legal Business Name): COLLEEN ANN BUCKLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E. 6TH ST. MCLAUGHLIN INDIAN HEALTH CENTER
MCLAUGHLIN SD
57642-0879
US

IV. Provider business mailing address

PO BOX 879 MCLAUGHLIN INDIAN HEALTH CENTER
MC LAUGHLIN SD
57642-0879
US

V. Phone/Fax

Practice location:
  • Phone: 605-823-4458
  • Fax: 605-823-4460
Mailing address:
  • Phone: 605-823-4458
  • Fax: 605-823-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR21707
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: