MEDICARE: MS. O. PATRICIA BUCKRIDGE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	439007-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386842524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. O. PATRICIA BUCKRIDGE RN

Provider Business Mailing Address
First Line	:	1030 MAYFAIR RD
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1547
Country	:	US
Telephone Number	:	516-223-5418
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 MAYFAIR RD
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1547
Country	:	US
Telephone Number	:	516-223-5418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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