Healthcare Provider Details

I. General information

NPI: 1043357551
Provider Name (Legal Business Name): THERESA ANN BUCHANAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHARLES W SCHIFFERT HEALTH CTR MCCOMAS HALL
BLACKSBURG VA
24061-0001
US

IV. Provider business mailing address

1220 PULASKI GILES TPKE
PEARISBURG VA
24134-2607
US

V. Phone/Fax

Practice location:
  • Phone: 540-231-5313
  • Fax: 540-231-7473
Mailing address:
  • Phone: 540-921-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number0024167130
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: