Provider Demographics
NPI:1497764476
Name:BUCHANAN, STACY B (RN, MS, CPNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:B
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:RN, MS, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-4706
Mailing Address - Country:US
Mailing Address - Phone:770-962-8025
Mailing Address - Fax:770-822-1573
Practice Address - Street 1:980 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-4706
Practice Address - Country:US
Practice Address - Phone:770-962-8025
Practice Address - Fax:770-822-1573
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160752363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics