Provider Demographics
NPI:1235480682
Name:BUCKLEY, ANNETTE (RN)
Entity Type:Individual
Prefix:MISS
First Name:ANNETTE
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112881
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06911-2881
Mailing Address - Country:US
Mailing Address - Phone:203-449-8219
Mailing Address - Fax:
Practice Address - Street 1:27 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2409
Practice Address - Country:US
Practice Address - Phone:203-449-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106707163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse