Provider Demographics
NPI:1093050692
Name:BUCKINGHAM, LIZA M (AUD)
Entity Type:Individual
Prefix:MS
First Name:LIZA
Middle Name:M
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:LIZA
Other - Middle Name:M
Other - Last Name:BUTTON BONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:5424 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2904
Practice Address - Country:US
Practice Address - Phone:757-345-6330
Practice Address - Fax:757-345-6896
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001668237700000X, 237600000X
VA2201001240231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter