Individual
LISA MARIE BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 441-8270
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN283523
MA
363LA2100X
Acute Care Nurse Practitioner
Primary
RN283523
MA
363LG0600X
Gerontology Nurse Practitioner
RN283523
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110104955A
—
MA
Enumeration date
08/04/2015
Last updated
03/08/2022
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