Individual
JEAN PATRICE BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
910 FREMONT ST, STEVENS PT., WI 54481
(715) 346-5000
Mailing address
910 FREMONT ST., STEVENS PT, WI 54481
(715) 346-4646
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
964
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42966800
—
WI
Enumeration date
01/11/2007
Last updated
05/20/2013
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