Provider Demographics
NPI:1083282057
Name:BUCHANAN, JUANITA MARIA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JUANITA
Middle Name:MARIA
Last Name:BUCHANAN
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 1:84-27 MIDLAND PKWY
Mailing Address - Street 2:APT 3B
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:347-299-0443
Mailing Address - Fax:
Practice Address - Street 1:84-27 MIDLAND PKWY
Practice Address - Street 2:APT 3B
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:347-299-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303061164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty