Provider Demographics
NPI:1194186064
Name:BUCHANAN, CHARLOTTE ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:ANN
Other - Last Name:PETROSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:10418 W HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6838
Mailing Address - Country:US
Mailing Address - Phone:316-305-6763
Mailing Address - Fax:
Practice Address - Street 1:3243 E MURDOCK ST STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3007
Practice Address - Country:US
Practice Address - Phone:316-305-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS799133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered