Provider Demographics
NPI:1740804392
Name:BUCKLEY, LORI K (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-1617
Mailing Address - Country:US
Mailing Address - Phone:970-234-5684
Mailing Address - Fax:
Practice Address - Street 1:708 6TH ST
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1617
Practice Address - Country:US
Practice Address - Phone:970-234-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI249751163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse