Individual
MS. MARIE ELLEN BUCKANAVAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1431 N CLAREMONT AVE FL 2, CHICAGO, IL 60622-1702
(312) 633-5890
Mailing address
3919 N RAVENSWOOD AVE APT 2, CHICAGO, IL 60613-2419
(203) 640-2402
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/11/2017
Last updated
03/17/2018
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