Provider Demographics
NPI:1477517969
Name:BUCHANAN, BETHANY VAYLE (ANP FAMILY NURSE PRA)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:VAYLE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:ANP FAMILY NURSE PRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 H ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501
Mailing Address - Country:US
Mailing Address - Phone:907-277-5677
Mailing Address - Fax:907-770-6707
Practice Address - Street 1:915 W NORTHERN LIGHTS
Practice Address - Street 2:AVANTE MEDICAL CENTER
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-770-6700
Practice Address - Fax:907-770-6707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily