Individual
MICHALIA COLLEEN BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-9040
Mailing address
55 FRUIT STREET, BOSTON, MA 02241-2696
(617) 724-9040
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
202325670
MA
363LP0200X
Pediatric Nurse Practitioner
202325670
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
MA
Other
Enumeration date
04/12/2023
Last updated
08/03/2023
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