Healthcare Provider Details

I. General information

NPI: 1346331899
Provider Name (Legal Business Name): EILEEN C. BUCHANAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FOSTER LANE
RESERVE NM
87830
US

IV. Provider business mailing address

PO BOX 889
DATIL NM
87821-0889
US

V. Phone/Fax

Practice location:
  • Phone: 505-533-6456
  • Fax: 505-533-6767
Mailing address:
  • Phone: 505-772-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR43468
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: