MEDICARE: SONIA E BUCKNOR NP

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	363LP0200X	Pediatric Nurse Practitioner	RN135486	AZ

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	:	1821000720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA E BUCKNOR NP

Provider Business Mailing Address
First Line	:	2701 E ELVIRA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-7124
Country	:	US
Telephone Number	:	520-874-7400
Fax Number	:	520-874-3425

Provider Business Practice Location Address
First Line	:	2225 E AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-6201
Country	:	US
Telephone Number	:	520-740-4569
Fax Number	:	520-740-2937

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	10/31/2007

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