Provider Demographics
NPI:1215479829
Name:BUCKLEY, RACHAEL (NP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 E BASELINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2000
Mailing Address - Country:US
Mailing Address - Phone:480-962-0101
Mailing Address - Fax:480-962-0202
Practice Address - Street 1:7615 E BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2000
Practice Address - Country:US
Practice Address - Phone:480-962-0101
Practice Address - Fax:480-962-0202
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily