Provider Demographics
NPI:1598278434
Name:BUCHANAN, MARY MELISSA (CNA)
Entity Type:Individual
Prefix:
First Name:MARY MELISSA
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 GOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-8210
Mailing Address - Country:US
Mailing Address - Phone:515-230-6691
Mailing Address - Fax:
Practice Address - Street 1:6101 GOODMAN DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:515-230-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA070780314000000X, 253Z00000X, 315D00000X, 374U00000X, 376K00000X, 385H00000X, 385HR2060X, 251G00000X
372600000X, 376J00000X
IA243999385H00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No253Z00000XAgenciesIn Home Supportive Care
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No374U00000XNursing Service Related ProvidersHome Health Aide
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Yes251G00000XAgenciesHospice Care, Community Based
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker