Provider Demographics
NPI:1720272420
Name:BUCKLEY, MEGAN RENEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:RENEE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4399 TIMES SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7112
Mailing Address - Country:US
Mailing Address - Phone:740-506-0807
Mailing Address - Fax:
Practice Address - Street 1:113 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9114
Practice Address - Country:US
Practice Address - Phone:740-852-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.333012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse