Provider Demographics
NPI:1689270084
Name:BUCHANAN, TABATHA ZAHN
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:ZAHN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 STILLWELL RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:WV
Mailing Address - Zip Code:26180-5577
Mailing Address - Country:US
Mailing Address - Phone:304-481-1107
Mailing Address - Fax:
Practice Address - Street 1:2108 CAMDEN AVE STE A
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5676
Practice Address - Country:US
Practice Address - Phone:304-422-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant