Healthcare Provider Details

I. General information

NPI: 1598278434
Provider Name (Legal Business Name): MARY MELISSA BUCHANAN CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 GOODMAN DR
URBANDALE IA
50322
US

IV. Provider business mailing address

6101 GOODMAN DR
URBANDALE IA
50322-8210
US

V. Phone/Fax

Practice location:
  • Phone: 515-230-6691
  • Fax:
Mailing address:
  • Phone: 515-230-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070780
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number070780
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number070780
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number070780
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number070780
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number070780
License Number StateIA
# 7
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number070780
License Number StateIA
# 8
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number070780
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: