Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 209018473 | IL |
NPI | 1013473305 |
---|---|
Provider Name | Laurie A Buckman |
First Address | Sterling, IL 61081-1252 |
Second Address | Sterling, IL 61081-1252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2019 |
Last Update Date | 12/02/2019 |