Provider Demographics
NPI:1154365054
Name:BUCKLEY, CYNTHIA J (RNPP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RNPP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PROVIDENCE COLLEGE STUDENT HEALTH SERVICES
Mailing Address - Street 2:549 RIVER AVE
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02918-0001
Mailing Address - Country:US
Mailing Address - Phone:401-865-2422
Mailing Address - Fax:401-865-2809
Practice Address - Street 1:PROVIDENCE COLLEGE STUDENT HEALTH SERVICES
Practice Address - Street 2:549 RIVER AVE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02918-0001
Practice Address - Country:US
Practice Address - Phone:401-865-2422
Practice Address - Fax:401-865-2809
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP20964363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICB35070Medicaid
RICB35070Medicaid
S66196Medicare UPIN