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Individual
MICHELLE M BUCK
Active
Individual
MICHELLE M BUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CNS
Taxonomy
Speciality
Code
Description
License number
State
163WX0800X
Orthopedic Registered Nurse
41249740
IL
364S00000X
Clinical Nurse Specialist
Primary
209000004
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA4748
MEDICARE RAILROAD PTAN (GROUP)
IL
01
—
P01334027
MEDICARE RAIL ROAD PTAN (INDIVIDUAL)
IL
Enumeration date
07/17/2006
Last updated
12/30/2014
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