Provider Demographics
NPI:1578738449
Name:BUCKLEY, NANCY (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 MAIN ST
Mailing Address - Street 2:RT. 539
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-3010
Mailing Address - Country:US
Mailing Address - Phone:800-950-6066
Mailing Address - Fax:
Practice Address - Street 1:1466 MAIN ST
Practice Address - Street 2:RT. 539
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-3010
Practice Address - Country:US
Practice Address - Phone:800-950-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP03059100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse