Provider Demographics
NPI:1861498032
Name:BUCKNER, CAROLE ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:ANNE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:ANNE
Other - Last Name:LARPENTEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 BLACK HILLS LN SW
Mailing Address - Street 2:STE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8144
Mailing Address - Country:US
Mailing Address - Phone:360-754-1735
Mailing Address - Fax:360-704-3404
Practice Address - Street 1:406 BLACK HILLS LN SW
Practice Address - Street 2:STE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8144
Practice Address - Country:US
Practice Address - Phone:360-754-1735
Practice Address - Fax:360-704-3404
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001203207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology