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General NPI Number Information
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NPI Number | 1497581862
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Entity Type | Individual
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Provider Name | DEBBIE BUCKLEY RN
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Gender | Female
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1600 OVERLAND AVE
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City | BURLEY
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State | ID
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Zip | 83318-2434
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Country | US
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Telephone | 208-219-4926
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Fax | 208-878-7073
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Provider Business Mailing Address
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Address Line | 714 N 1100 E
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City | JACKSON
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State | ID
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Zip | 83350-5038
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Country | US
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Telephone | 423-641-6439
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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 | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 71344
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License Number State | ID
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