Provider Demographics
NPI:1558511279
Name:BUCKLEY, COLLEEN ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:MCLAUGHLIN INDIAN HEALTH CENTER
Mailing Address - City:MC LAUGHLIN
Mailing Address - State:SD
Mailing Address - Zip Code:57642-0879
Mailing Address - Country:US
Mailing Address - Phone:605-823-4458
Mailing Address - Fax:605-823-4460
Practice Address - Street 1:701 E. 6TH ST.
Practice Address - Street 2:MCLAUGHLIN INDIAN HEALTH CENTER
Practice Address - City:MCLAUGHLIN
Practice Address - State:SD
Practice Address - Zip Code:57642-0879
Practice Address - Country:US
Practice Address - Phone:605-823-4458
Practice Address - Fax:605-823-4460
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2011-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NDR21707163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health