Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704222958 | MI |
NPI | 1073175303 |
---|---|
Provider Name | Mrs. Anita L Buckner |
First Address | Norton Shores, MI 49441-6011 |
Second Address | Norton Shores, MI 49441-6011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2019 |
Last Update Date | 08/07/2019 |