Provider Demographics
NPI:1326656935
Name:BUCKLEY, LORI (MSN, RN)
Entity Type:Individual
Prefix:PROF
First Name:LORI
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WEST ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3935
Mailing Address - Country:US
Mailing Address - Phone:410-758-7779
Mailing Address - Fax:
Practice Address - Street 1:1901 WEST ST UNIT 204
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3935
Practice Address - Country:US
Practice Address - Phone:410-758-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185850163WA2000X, 163WM0705X, 163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB240546501663OtherDRIVERS LICENSE