Provider Demographics
NPI:1770845026
Name:BUCKLEY, TRACY AMANDA (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:AMANDA
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:AMANDA
Other - Last Name:TRUELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:368 ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1323
Mailing Address - Country:US
Mailing Address - Phone:716-632-2936
Mailing Address - Fax:
Practice Address - Street 1:368 ELLEN DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1323
Practice Address - Country:US
Practice Address - Phone:716-632-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY571649-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse