Provider Demographics
NPI:1609028786
Name:BUCHANAN, LILLIAN ARZELIA (APRN)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:ARZELIA
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-5347
Mailing Address - Country:US
Mailing Address - Phone:816-655-5741
Mailing Address - Fax:816-655-5367
Practice Address - Street 1:2734 N 10TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-5347
Practice Address - Country:US
Practice Address - Phone:816-655-5741
Practice Address - Fax:816-655-5367
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1344449102364S00000X
MO097904364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
425016003Medicare UPIN