Healthcare Provider Details

I. General information

NPI: 1669367595
Provider Name (Legal Business Name): ISABEL GRACE BUCKINGHAM MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CURIE BLVD
PHILADELPHIA PA
19104-4217
US

IV. Provider business mailing address

418 CURIE BLVD
PHILADELPHIA PA
19104-4217
US

V. Phone/Fax

Practice location:
  • Phone: 215-898-8281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberL1-0073825
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NR26651000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN787367
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: