Healthcare Provider Details

I. General information

NPI: 1437285327
Provider Name (Legal Business Name): JENNIFER RASMUSSEN BUCKINGHAM A.T.,C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER MARIE RASMUSSEN A.T.,C.

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANSING COMMUNITY COLLEGE PHYSICAL FITNESS AND WELLNESS DEPARTMENT-5600
LANSING MI
48901-7210
US

IV. Provider business mailing address

1571 GALE RD
EATON RAPIDS MI
48827-9610
US

V. Phone/Fax

Practice location:
  • Phone: 517-483-1227
  • Fax: 517-483-9839
Mailing address:
  • Phone: 517-663-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: