Provider Demographics
NPI:1225464043
Name:BUCHANAN, LATOYA DIMITRA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:DIMITRA
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:DIMITRA
Other - Last Name:CHAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:264 AVERASBORO DR.
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520
Mailing Address - Country:US
Mailing Address - Phone:919-432-7395
Mailing Address - Fax:
Practice Address - Street 1:264 AVERASBORO DR.
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520
Practice Address - Country:US
Practice Address - Phone:919-432-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC240383163WC1500X
NC5013479363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health