Provider Demographics
NPI:1437285327
Name:BUCKINGHAM, JENNIFER RASMUSSEN (AT,C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RASMUSSEN
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT,C
Mailing Address - Street 1:1571 GALE RD
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-9610
Mailing Address - Country:US
Mailing Address - Phone:517-663-5526
Mailing Address - Fax:
Practice Address - Street 1:LANSING COMMUNITY COLLEGE
Practice Address - Street 2:PHYSICAL FITNESS AND WELLNESS DEPARTMENT-5600
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48901-7210
Practice Address - Country:US
Practice Address - Phone:517-483-1227
Practice Address - Fax:517-483-9839
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI22OtherATHLETIC TRAINER