Provider Demographics
NPI:1043578941
Name:BUCHANAN, KAREN LUCILLE
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LUCILLE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14340 COUNTY ROAD 19
Mailing Address - Street 2:
Mailing Address - City:WEST UNITY
Mailing Address - State:OH
Mailing Address - Zip Code:43570-9717
Mailing Address - Country:US
Mailing Address - Phone:419-924-2614
Mailing Address - Fax:
Practice Address - Street 1:14340 COUNTY ROAD 19
Practice Address - Street 2:
Practice Address - City:WEST UNITY
Practice Address - State:OH
Practice Address - Zip Code:43570-9717
Practice Address - Country:US
Practice Address - Phone:419-924-2614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0060825Medicaid