MEDICARE: WENDY M BUCHANAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1245893411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY M BUCHANAN

Provider Business Mailing Address
First Line	:	3085 PINECREST WAY
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1854
Country	:	US
Telephone Number	:	248-373-1855
Fax Number	:

Provider Business Practice Location Address
First Line	:	4128 BALDWIN RD
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1223
Country	:	US
Telephone Number	:	248-334-5177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	04/15/2019

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