Provider Demographics
NPI:1396985040
Name:BUCKINGHAM, KATHERINE SUZANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:SUZANNE
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A CO, 121 CSH
Mailing Address - Street 2:UNIT 15244, BOX 55
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205
Mailing Address - Country:US
Mailing Address - Phone:937-412-0894
Mailing Address - Fax:
Practice Address - Street 1:A CO, 121 CSH
Practice Address - Street 2:UNIT 15244, BOX 55
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:US
Practice Address - Phone:315-737-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH319311163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherTRICARE