Provider Demographics
NPI:1245226802
Name:BUCHANAN, RENEE GRIFFIN (PA C)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:GRIFFIN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:L
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1340 RYAN PKWY
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-4527
Mailing Address - Country:US
Mailing Address - Phone:815-276-0150
Mailing Address - Fax:877-461-6742
Practice Address - Street 1:912 NORTHWEST HWY
Practice Address - Street 2:STE 107
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1925
Practice Address - Country:US
Practice Address - Phone:847-462-5100
Practice Address - Fax:847-462-5101
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant