Individual
MS. GWENDORIA BUCKLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501
(707) 268-2990
Mailing address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2990
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN067802
LA
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
811867
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN067802
LA STATE BOARD OF NURSING
LA
Enumeration date
08/12/2008
Last updated
01/09/2019
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