Provider Demographics
NPI:1124893292
Name:BUCHANAN, RITA M (DOULA)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:M
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1607
Mailing Address - Country:US
Mailing Address - Phone:631-205-4243
Mailing Address - Fax:
Practice Address - Street 1:21 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1607
Practice Address - Country:US
Practice Address - Phone:631-205-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula