Provider Demographics
NPI:1427034552
Name:BUCHANAN, DONNA JEAN (PMHNP, FNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEAN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:C
Other - Last Name:GARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-FNP-BC
Mailing Address - Street 1:450 S WILLARD ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6743
Mailing Address - Country:US
Mailing Address - Phone:928-634-5551
Mailing Address - Fax:928-634-5604
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:SUITE 115
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6743
Practice Address - Country:US
Practice Address - Phone:928-634-5551
Practice Address - Fax:928-634-5604
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8776363LP0808X
AZAP7273363LF0000X
VAMSL0001166078VA163W00000X
VA0024166643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010288711Medicaid
VA010288711Medicaid
Q64251Medicare UPIN