Provider Demographics
NPI:1639294531
Name:BUCKLEY, HEATHER P (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:P
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 1:21 ASHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-4403
Mailing Address - Country:US
Mailing Address - Phone:978-884-9946
Mailing Address - Fax:
Practice Address - Street 1:21 ASHWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-4403
Practice Address - Country:US
Practice Address - Phone:978-884-9946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53262164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse