Provider Demographics
NPI:1851935548
Name:BUCHANAN, THYRA ISELA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:THYRA
Middle Name:ISELA
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PROFESSIONAL DR STE 370
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7670
Mailing Address - Country:US
Mailing Address - Phone:678-869-5145
Mailing Address - Fax:678-869-5148
Practice Address - Street 1:601 PROFESSIONAL DR STE 370
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7670
Practice Address - Country:US
Practice Address - Phone:678-869-5145
Practice Address - Fax:678-869-5148
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN189171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily