Healthcare Provider Details

I. General information

NPI: 1568404523
Provider Name (Legal Business Name): CATHERINE A BUCK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 AVON ST SUITE 9
CHARLOTTESVILLE VA
22902-5750
US

IV. Provider business mailing address

PO BOX 1583
CHARLOTTESVILLE VA
22902-1583
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-1818
  • Fax: 434-817-9607
Mailing address:
  • Phone: 434-654-7794
  • Fax: 434-654-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024125896
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0024125896
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: