# MS. MARILYN ELIZABETH BUCKLEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1871676049
- **Gender:** F
- **Credential:** MSN, CFNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 4704118735 | MI | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 10/19/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 200893159 | TAX ID | MI |
| 01 | — | 23D1031156 | CLIA NUMBER | MI |
| 05 | — | 46273355 TYPE 10 | — | MI |
| 01 | — | 4704118735 | STATE LIC NUMBER | MI |
| 01 | — | 5008703250 | BCBS OF MICHIGAN PROV ID | MI |
| 01 | — | 5008703250 | BCBS OF MICHIGAN | — |