Healthcare Provider Details

I. General information

NPI: 1790157915
Provider Name (Legal Business Name): JENNIFER BUCHANAN CNM, WHNP-BC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 EL CENTRO ST SUITE 100
SOUTH PASADENA CA
91030-3202
US

IV. Provider business mailing address

125 N RAYMOND AVE UNIT 202
PASADENA CA
91103-4535
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2229
  • Fax:
Mailing address:
  • Phone: 626-818-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number235772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: