Individual
MS. MARILYN ELIZABETH BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, CFNP
Contact information
Practice address
117 S. BURGESS ST., WEST BRANCH, MI 48661
(989) 343-1367
(989) 343-1427
Mailing address
117 S. BURGESS ST., WEST BRANCH, MI 48661
(989) 343-1367
(989) 343-1427
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704118735
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200893159
TAX ID
MI
01
—
23D1031156
CLIA NUMBER
MI
05
—
46273355 TYPE 10
—
MI
01
—
4704118735
STATE LIC NUMBER
MI
01
—
5008703250
BCBS OF MICHIGAN PROV ID
MI
01
—
5008703250
BCBS OF MICHIGAN
—
Enumeration date
10/23/2006
Last updated
10/19/2017
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