Provider Demographics
NPI:1164996336
Name:BUCKLER, MAHEALANI KIM (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MAHEALANI
Middle Name:KIM
Last Name:BUCKLER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:MAHEALANI
Other - Middle Name:KIM
Other - Last Name:CROSSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8781 TOMMY DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2013
Mailing Address - Country:US
Mailing Address - Phone:303-859-1931
Mailing Address - Fax:
Practice Address - Street 1:8325 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9322
Practice Address - Country:US
Practice Address - Phone:619-343-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA782243163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant