Provider Demographics
NPI:1154464659
Name:BUCKLEY, EFFIE MAE (RN, MN)
Entity Type:Individual
Prefix:
First Name:EFFIE MAE
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RN, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7174 SANTA TERESA BLVD.
Mailing Address - Street 2:A-6
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95139-1135
Mailing Address - Country:US
Mailing Address - Phone:408-363-1498
Mailing Address - Fax:408-363-1599
Practice Address - Street 1:7174 SANTA TERESA BLVD
Practice Address - Street 2:A-6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95139-1350
Practice Address - Country:US
Practice Address - Phone:408-363-1498
Practice Address - Fax:408-363-1599
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN265730163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice