Basic Information
| Provider Information | |||||||||
| NPI: | 1528247475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCKMIRE | ||||||||
| FirstName: | DAWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 196 THOMAS JOHNSON DR | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016689988 | ||||||||
| FaxNumber: | 2407821013 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 SHERRY LN | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206783275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104149229 | ||||||||
| FaxNumber: | 4104149339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2007 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R133890 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | R133890 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.