Provider Demographics
NPI:1174744742
Name:BUCKLEY, DENISE GRACE (RNC)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:GRACE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-326-0965
Mailing Address - Fax:617-353-3557
Practice Address - Street 1:881 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-353-3575
Practice Address - Fax:617-353-3557
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77026363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA77026OtherSTATE LISC.