Provider Demographics
NPI:1477066199
Name:BUKLEY, LANA
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:BUKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:BUKLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1350 15TH ST APT 15M
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2030
Mailing Address - Country:US
Mailing Address - Phone:908-670-3322
Mailing Address - Fax:
Practice Address - Street 1:110 N FEDERAL HWY STE 204
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4300
Practice Address - Country:US
Practice Address - Phone:954-899-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403604363LP0808X
NJ26NJ00761700363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care