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General NPI Number Information
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NPI Number | 1689801888
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Entity Type | Individual
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Provider Name | BRENDA SUE BUCKLE ANP, BC
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Gender | Female
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 5020 W BRISTOL RD
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City | FLINT
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State | MI
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Zip | 48507-2919
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Country | US
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Telephone | 800-600-2009
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Fax | 810-600-0896
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Provider Business Mailing Address
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Address Line | 5020 W BRISTOL RD
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City | FLINT
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State | MI
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Zip | 48507-2919
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Country | US
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Telephone | 800-600-2009
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Fax | 810-600-0896
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4714205380
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License Number State | MI
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