Basic Information
Provider Information
NPI: 1003146242
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUCK
FirstName: ROBERT
MiddleName: T
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 480 GALLETTI WAY
Address2:  
City: SPARKS
State: NV
PostalCode: 894315564
CountryCode: US
TelephoneNumber: 7756882001
FaxNumber: 7756882004
Practice Location
Address1: 480 GALLETTI WAY
Address2:  
City: SPARKS
State: NV
PostalCode: 894315564
CountryCode: US
TelephoneNumber: 7756882001
FaxNumber: 7756882004
Other Information
ProviderEnumerationDate: 01/11/2010
LastUpdateDate: 01/11/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRNNVY Nursing Service ProvidersRegistered Nurse 

ID Information
IDTypeStateIssuerDescription
RN1557901NVREGISTERED NURSEOTHER


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