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NPI Code Detail

MEDICARE: MRS. LISA M BUCKLIN CNP

MEDICARE: MRS. LISA M BUCKLIN CNP
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
1363L00000XNurse PractitionerR022487SD
2363L00000XNurse PractitionerR-158898-7MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841296555
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA M BUCKLIN CNP
Provider Business Mailing Address
First Line : 205 ORCHARD DR
Second Line :
City : SISSETON
State : SD
Zip : 57262-2312
Country : US
Telephone Number : 605-698-7681
Fax Number : 605-698-3493
Provider Business Practice Location Address
First Line : 205 ORCHARD DR
Second Line :
City : SISSETON
State : SD
Zip : 57262-2312
Country : US
Telephone Number : 605-698-7681
Fax Number : 605-698-3493
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 07/08/2007

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Directions to “ MRS. LISA M BUCKLIN CNP” Practice Location

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