Provider Demographics
NPI:1982621421
Name:BUCK, MICHELLE M (RN, CNS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:BUCK
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:HEUERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:27650 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3845
Mailing Address - Country:US
Mailing Address - Phone:630-225-2663
Mailing Address - Fax:630-225-2399
Practice Address - Street 1:27650 FERRY RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3845
Practice Address - Country:US
Practice Address - Phone:630-225-2663
Practice Address - Fax:630-225-2399
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41249740163WX0800X
IL209000004364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCA4748OtherMEDICARE RAILROAD PTAN (GROUP)
ILP01334027OtherMEDICARE RAIL ROAD PTAN (INDIVIDUAL)
ILF400102820Medicare PIN