Healthcare Provider Details

I. General information

NPI: 1891774352
Provider Name (Legal Business Name): CRYSTAL A BUCHANAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MADISON STREET
AUBURN ME
04210
US

IV. Provider business mailing address

125 MADISON STREET
AUBURN ME
04210
US

V. Phone/Fax

Practice location:
  • Phone: 207-891-9749
  • Fax: 270-294-7300
Mailing address:
  • Phone: 207-891-9749
  • Fax: 270-294-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP81736
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: