Theresa S Buckley, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2306 Issued in WI

Practice address

207 King Olaf CT
Colfax, WI 54730-9517

Phone

(715) 962-2285

Fax

(715) 962-2285

NPI assigned

Jan 16, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Theresa L Stovern Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248739200000",
    "number": "1043299209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 KING OLAF COURT",
            "city": "COLFAX",
            "state": "WI",
            "postal_code": "54730",
            "telephone_number": "715-962-2285",
            "fax_number": "715-962-2285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 KING OLAF CT",
            "city": "COLFAX",
            "state": "WI",
            "postal_code": "547309517",
            "telephone_number": "715-962-2285",
            "fax_number": "715-962-2285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "THERESA",
        "middle_name": "S",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-16",
        "last_updated": "2009-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "2306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41175800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "STOVERN",
            "middle_name": "L",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Arvold Chiropractic of Birchwood, LTD.
• Daniel T Arvold, DC
• George William Berres, D.C.,C.C.S.P.
• Cheyenne Bielmeier
• Alexander Timothy Boyer, DPT
• Lana Marie Christoffel
• Colfax Health and Rehabilitation Center, Inc.
• Leda Estrella Forseen, LPN
• Taylor Jean Hellmann, RN
• Helping Hands Healthcare

• All providers in Colfax, WI
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.