Healthcare Provider Details

I. General information

NPI: 1932299880
Provider Name (Legal Business Name): JENNIFER BETH BUCHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 NE SAND HILL RD
BELFAIR WA
98528-9007
US

IV. Provider business mailing address

3908 10TH ST SE
PUYALLUP WA
98374-2188
US

V. Phone/Fax

Practice location:
  • Phone: 360-277-2444
  • Fax: 360-277-2441
Mailing address:
  • Phone: 253-848-5951
  • Fax: 253-845-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004759
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: