Provider Demographics
NPI:1235667478
Name:BUCKLEY UHRICH, DIANA ELIZABETH (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ELIZABETH
Last Name:BUCKLEY UHRICH
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
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Mailing Address - Street 1:18 MAPLE CIR
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1115
Mailing Address - Country:US
Mailing Address - Phone:978-239-7017
Mailing Address - Fax:617-643-0623
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-643-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1706087363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty