Healthcare Provider Details

I. General information

NPI: 1114271798
Provider Name (Legal Business Name): KRISTEN MARIE BUCHANAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MARIE MANNIER AND SOFIA

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N 51ST AVE STE 4
PHOENIX AZ
85031-1237
US

IV. Provider business mailing address

9059 W. LAKE PLEASANT PKWY STE E-540
PEORIA AZ
85382
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7575
  • Fax: 623-247-6386
Mailing address:
  • Phone: 623-322-3380
  • Fax: 623-322-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number5200
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: