Provider Demographics
NPI:1588839799
Name:BUCHANAN, PETRA AMLIN (L,AC)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:AMLIN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:L,AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2452
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-2452
Mailing Address - Country:US
Mailing Address - Phone:970-708-9677
Mailing Address - Fax:
Practice Address - Street 1:35 PILOT KNOB LANE
Practice Address - Street 2:#704
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-708-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1101171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist