Provider Demographics
NPI:1083677165
Name:BUCKNER, BAILENE ORTEZ (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BAILENE
Middle Name:ORTEZ
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 DEMOREST RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1101
Mailing Address - Country:US
Mailing Address - Phone:614-207-8915
Mailing Address - Fax:
Practice Address - Street 1:447 DEMOREST RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1101
Practice Address - Country:US
Practice Address - Phone:614-207-8915
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH099939164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse