Provider Demographics
NPI:1508629932
Name:BUCKLEY, EMILY MARIE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MARIE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2671
Mailing Address - Country:US
Mailing Address - Phone:508-369-6099
Mailing Address - Fax:
Practice Address - Street 1:136 OAK ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2671
Practice Address - Country:US
Practice Address - Phone:508-369-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2335512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily