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General NPI Number Information
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NPI Number | 1871676049
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Entity Type | Individual
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Provider Name | MARILYN ELIZABETH BUCKLEY MSN, CFNP
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 117 S. BURGESS ST.
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City | WEST BRANCH
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State | MI
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Zip | 48661
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Country | US
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Telephone | 989-343-1367
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Fax | 989-343-1427
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Provider Business Mailing Address
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Address Line | 117 S. BURGESS ST.
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City | WEST BRANCH
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State | MI
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Zip | 48661
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Country | US
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Telephone | 989-343-1367
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Fax | 989-343-1427
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704118735
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License Number State | MI
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