Provider Demographics
NPI:1609387661
Name:BUCKLEY, MAURA THOENES (PA-C)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:THOENES
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:MICHELLE
Other - Last Name:THOENES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:805 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CA
Mailing Address - Zip Code:95570-8704
Mailing Address - Country:US
Mailing Address - Phone:727-460-5836
Mailing Address - Fax:
Practice Address - Street 1:2316 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3217
Practice Address - Country:US
Practice Address - Phone:707-442-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical