Provider Demographics
NPI:1083236996
Name:BUCHANAN, LATISHA ISHEEMA (TRICHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:ISHEEMA
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:TRICHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 GUESS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2668
Mailing Address - Country:US
Mailing Address - Phone:919-698-9974
Mailing Address - Fax:
Practice Address - Street 1:3215 GUESS RD STE 101
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2668
Practice Address - Country:US
Practice Address - Phone:919-698-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty