Provider Demographics
NPI:1790157915
Name:BUCHANAN, JENNIFER (CNM, WHNP-BC, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:CNM, WHNP-BC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N RAYMOND AVE UNIT 202
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-4535
Mailing Address - Country:US
Mailing Address - Phone:626-818-9204
Mailing Address - Fax:
Practice Address - Street 1:1416 EL CENTRO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3202
Practice Address - Country:US
Practice Address - Phone:626-577-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235772367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife