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Individual

LISA BUCKINGHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1 WYOMING ST, DAYTON, OH 45409-2722
(937) 208-6173
(937) 208-3843
Mailing address
1 WYOMING ST, DAYTON, OH 45409-2722
(937) 208-6173
(937) 208-3843

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
048905
OH
207L00000X
Anesthesiology Physician
RN210684
OH
367500000X
Certified Registered Nurse Anesthetist
RN210684
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2189671
OH
Enumeration date
02/16/2007
Last updated
05/08/2020
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