Provider Demographics
NPI:1629401062
Name:BUCKLEY, ROBIN LESLEY (RN)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LESLEY
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 CAVALIER WAY
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-3364
Mailing Address - Country:US
Mailing Address - Phone:864-582-4347
Mailing Address - Fax:864-587-8738
Practice Address - Street 1:1050 CAVALIER WAY
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3364
Practice Address - Country:US
Practice Address - Phone:864-582-4347
Practice Address - Fax:864-587-8738
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC446107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse