Provider Demographics
NPI:1003861063
Name:BUCHANNAN, ELLEN G (NP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:G
Last Name:BUCHANNAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 E MISSISSIPPI AVE
Mailing Address - Street 2:120
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3561
Mailing Address - Country:US
Mailing Address - Phone:303-695-8684
Mailing Address - Fax:303-597-0191
Practice Address - Street 1:13650 E MISSISSIPPI AVE
Practice Address - Street 2:120
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3561
Practice Address - Country:US
Practice Address - Phone:303-695-8684
Practice Address - Fax:303-597-0191
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78467163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805283Medicare ID - Type Unspecified
COQ68740Medicare UPIN