Provider Demographics
NPI:1790318939
Name:BUCHANAN, SANDRA ANN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
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 1:4200 OLD SPRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085
Mailing Address - Country:US
Mailing Address - Phone:817-599-7604
Mailing Address - Fax:
Practice Address - Street 1:4200 OLD SPRINGTON RD
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76085
Practice Address - Country:US
Practice Address - Phone:817-599-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider