Provider Demographics
NPI:1790570877
Name:BUCKLEY, MELVIN CHARLES JR
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:CHARLES
Last Name:BUCKLEY
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 N 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-4110
Mailing Address - Country:US
Mailing Address - Phone:402-769-8321
Mailing Address - Fax:
Practice Address - Street 1:3811 N 88TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4110
Practice Address - Country:US
Practice Address - Phone:402-769-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion