Provider Demographics
NPI:1730396193
Name:BUCKLEY, PETCHARAT ----------- (RN)
Entity type:Individual
Prefix:MS
First Name:PETCHARAT
Middle Name:-----------
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 1:5228 TUXWORTH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5832
Mailing Address - Country:US
Mailing Address - Phone:614-834-0840
Mailing Address - Fax:
Practice Address - Street 1:5228 TUXWORTH DR
Practice Address - Street 2:7895 SMITH CALHOUN RD ,PLAIN CITY,OH
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5832
Practice Address - Country:US
Practice Address - Phone:614-834-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225246163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2160969OtherIP NURSE,RN