1437285327 NPI number — MRS. JENNIFER RASMUSSEN BUCKINGHAM A.T.,C.

Table of content: MRS. JENNIFER RASMUSSEN BUCKINGHAM A.T.,C. (NPI 1437285327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437285327 NPI number — MRS. JENNIFER RASMUSSEN BUCKINGHAM A.T.,C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKINGHAM
Provider First Name:
JENNIFER
Provider Middle Name:
RASMUSSEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
A.T.,C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RASMUSSEN
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
A.T.,C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437285327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1571 GALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATON RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48827-9610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-663-5526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LANSING COMMUNITY COLLEGE
Provider Second Line Business Practice Location Address:
PHYSICAL FITNESS AND WELLNESS DEPARTMENT-5600
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48901-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-483-1227
Provider Business Practice Location Address Fax Number:
517-483-9839
Provider Enumeration Date:
02/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22 . This is a "ATHLETIC TRAINER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".