Provider Demographics
NPI:1518146273
Name:BUCKLEY, REBECKAH B (CNM)
Entity Type:Individual
Prefix:
First Name:REBECKAH
Middle Name:B
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 13 BOX 321
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84629-5528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 S MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-2222
Practice Address - Country:US
Practice Address - Phone:435-462-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360755-3102163WD0400X
UT367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator