Provider Demographics
NPI:1770725657
Name:BUCHANAN, JAMIKA
Entity type:Individual
Prefix:
First Name:JAMIKA
Middle Name:
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 1:140 ELGAR PL
Mailing Address - Street 2:APT # 4-E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5201
Mailing Address - Country:US
Mailing Address - Phone:646-431-9142
Mailing Address - Fax:
Practice Address - Street 1:140 ELGAR PL
Practice Address - Street 2:APT # 4-E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5201
Practice Address - Country:US
Practice Address - Phone:646-431-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294085164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse