Provider Demographics
NPI:1235177296
Name:BUCKLEY, TAMARA MOROUSE (MSN,PNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:MOROUSE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MSN,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 UNIVERSITY BLVD W
Mailing Address - Street 2:STE 112
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1948
Mailing Address - Country:US
Mailing Address - Phone:301-681-6730
Mailing Address - Fax:301-681-4268
Practice Address - Street 1:344 UNIVERSITY BLVD W
Practice Address - Street 2:STE 112
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1948
Practice Address - Country:US
Practice Address - Phone:301-681-6730
Practice Address - Fax:301-681-4268
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIR092856363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD33194OtherPRIORITY PRTNERS MCO
DC5666-0004OtherBLUE CROSS/BLUE SHIELD