MEDICARE: JANET C BUCHANAN NNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0000X	Neonatal Nurse Practitioner	215155-4405	UT

General Provider Information

NPI Number	:	1619152444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET C BUCHANAN NNP

Provider Business Mailing Address
First Line	:	5121 SOUTH COTTONWOOD DRIVE
Second Line	:	NEWBORN ICU
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84157-7000
Country	:	US
Telephone Number	:	801-408-3482
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 SOUTH COTTONWOOD DRIVE
Second Line	:	NEWBORN ICU
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84157-7000
Country	:	US
Telephone Number	:	801-408-3482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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