| NPI | 1962906982 |
|---|---|
| Former Name | TANELLE NICOLE BUCKLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 6157) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 6157) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2021-08-09 |