Provider Demographics
NPI:1760458541
Name:BUCKLEY, SUSAN R (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:DEMARCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:246 PLEASANT ST
Mailing Address - Street 2:SUITE G2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-224-3388
Mailing Address - Fax:603-225-3557
Practice Address - Street 1:246 PLEASANT ST
Practice Address - Street 2:SUITE G2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-224-3388
Practice Address - Fax:603-225-3557
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH039259-23-03363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3222724OtherCIGNA PIN
NH4006777Y0NH04OtherANTHEM ACES #
NH30340222Medicaid
NHS83646OtherANTHEM REFERRING UPIN
NHS83646OtherEPS HPHC PIN
NH30340222Medicaid
S83646Medicare UPIN