Provider Demographics
NPI:1073872057
Name:BUCKINGHAM, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 WEIMER RD
Mailing Address - Street 2:DIABETES MANAGEMENT PROGRAM
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:DIABETES MANAGEMENT PROGRAM
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6253
Practice Address - Country:US
Practice Address - Phone:575-737-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR22682163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator