Provider Demographics
NPI:1235188111
Name:BUCHANAN, HOLLY ANN (NP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:109 WIMBLEDON SQ
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4945
Mailing Address - Country:US
Mailing Address - Phone:757-549-2973
Mailing Address - Fax:757-549-2973
Practice Address - Street 1:109 WIMBLEDON SQ
Practice Address - Street 2:SUITE E
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4945
Practice Address - Country:US
Practice Address - Phone:757-549-2973
Practice Address - Fax:757-549-2973
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q45383Medicare UPIN