Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 16437 | NE |
NPI | 1063441277 |
---|---|
Provider Name | Krynn Keller Buckley |
First Address | Lancaster, WI 53813-2054 |
Second Address | Lancaster, WI 53813-2054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 22/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47059666513 | (05) | NE |
F01573 | (02) |