Provider Demographics
NPI:1063029783
Name:BUCKMILLER, GIOVANNA ROXANA (MC6503)
Entity Type:Individual
Prefix:MISS
First Name:GIOVANNA
Middle Name:ROXANA
Last Name:BUCKMILLER
Suffix:
Gender:F
Credentials:MC6503
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 113TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7429
Mailing Address - Country:US
Mailing Address - Phone:425-232-6356
Mailing Address - Fax:
Practice Address - Street 1:2515 113TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7429
Practice Address - Country:US
Practice Address - Phone:425-232-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC6503171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty