Provider Demographics
NPI:1518183227
Name:BUCKELEW, LAURIE ANN SOWLER (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANN SOWLER
Last Name:BUCKELEW
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 W AJO HWY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85735-2128
Mailing Address - Country:US
Mailing Address - Phone:520-822-2277
Mailing Address - Fax:520-822-2041
Practice Address - Street 1:16350 W AJO HWY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85735-2126
Practice Address - Country:US
Practice Address - Phone:520-822-9343
Practice Address - Fax:520-822-5081
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN035459163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ594847Medicaid