Provider Demographics
NPI:1730577883
Name:BUCKHAM, SAMANTHA (LPN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BUCKHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E 31ST ST
Mailing Address - Street 2:APT C6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7974
Mailing Address - Country:US
Mailing Address - Phone:352-777-9469
Mailing Address - Fax:
Practice Address - Street 1:322 E 31ST ST
Practice Address - Street 2:APT C6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7974
Practice Address - Country:US
Practice Address - Phone:352-777-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318644-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care