| Doctor Name: | MS. MARLA DIANNE BUCKLES |
| NPI Number: | 1043208838 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 241753 |
| Business Practice Address: | 208 W Casablanca Ave 27 Medical Group Bldg 1400 Cannon Afb Clovis, NM - 881035009 |
| Business Phone Number: | 5057846608 |
| Business Fax Number: | 5057846028 |
| Mailing Address: | 208 W Casablanca Ave, 27 Medical Group Bldg 1400 Cannon Afb CLOVIS |
| State: | NM |
| Postal Code: | 881015014 |
| Phone Number: | 5057846605 |
| Fax Number: | 5057846028 |
| NPI Enumeration Date: | 10/06/2005 |
| NPI Last Update Date: | 10/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 241753 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |