MEDICARE: MRS. AVIS CAROL BUCHANAN MSN, B.C.

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	163WA2000X	Administrator Registered Nurse	31238	SC

General Provider Information

NPI Number	:	1902041049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AVIS CAROL BUCHANAN MSN, B.C.

Provider Business Mailing Address
First Line	:	201 RAINSBOROUGH WAY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8870
Country	:	US
Telephone Number	:	803-419-9343
Fax Number	:	803-898-4899

Provider Business Practice Location Address
First Line	:	2414 BULL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-1906
Country	:	US
Telephone Number	:	803-898-4867
Fax Number	:

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

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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