Provider Demographics
NPI:1346581949
Name:BUCKNER, DEMETRIA (BS HEALTH SCIENCES,)
Entity Type:Individual
Prefix:MISS
First Name:DEMETRIA
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:BS HEALTH SCIENCES,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 A WEST 86TH ST #1289
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3605
Mailing Address - Country:US
Mailing Address - Phone:317-567-1293
Mailing Address - Fax:317-981-3979
Practice Address - Street 1:5901 WALSHAM WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2327
Practice Address - Country:US
Practice Address - Phone:317-509-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator