Provider Demographics
NPI:1346571965
Name:BUCKNER, KAREN RENEE (DT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RENEE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 ONARGA ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2131
Mailing Address - Country:US
Mailing Address - Phone:708-898-7600
Mailing Address - Fax:708-503-9113
Practice Address - Street 1:347 ONARGA ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2131
Practice Address - Country:US
Practice Address - Phone:708-898-7600
Practice Address - Fax:708-503-9113
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist