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General NPI Number Information
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NPI Number | 1346724705
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Entity Type | Individual
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Provider Name | OLIVIA BUCKLEY
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Gender | Female
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-3618
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Country | US
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Telephone | 216-444-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 E STILL CIR
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City | MESA
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State | AZ
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Zip | 85206-3618
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 1225480
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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