Provider Demographics
NPI:1689996399
Name:BUCKLE-WRIGHT, CHARMAINE EMELINE (LPN)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:EMELINE
Last Name:BUCKLE-WRIGHT
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 1:17728 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-1805
Mailing Address - Country:US
Mailing Address - Phone:347-469-8087
Mailing Address - Fax:
Practice Address - Street 1:17728 106TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1805
Practice Address - Country:US
Practice Address - Phone:347-469-8087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297766164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY297766OtherNYS NURSING LICENSE LPN