Healthcare Provider Details

I. General information

NPI: 1518146273
Provider Name (Legal Business Name): REBECKAH B BUCKLEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S MEDICAL DR
MT PLEASANT UT
84647-2222
US

IV. Provider business mailing address

HC 13 BOX 321
FAIRVIEW UT
84629-5528
US

V. Phone/Fax

Practice location:
  • Phone: 435-462-2441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number360755-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: