Provider Demographics
NPI:1114773991
Name:BUCKINGHAM, ROSE ANN (DNP, RN)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:ANN
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:DNP, RN
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:ANN
Other - Last Name:TRIBULATO (O'CONNOR)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12040 NE 128TH ST # MS 103
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-218-7070
Mailing Address - Fax:
Practice Address - Street 1:12040 NE 128TH ST # MS 103
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-218-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60797089163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health