Provider Demographics
NPI:1821000720
Name:BUCKNOR, SONIA E (NP)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:E
Last Name:BUCKNOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-7400
Mailing Address - Fax:520-874-3425
Practice Address - Street 1:2225 E AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6201
Practice Address - Country:US
Practice Address - Phone:520-740-4569
Practice Address - Fax:520-740-2937
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN135486363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ045230Medicaid