Provider Demographics
NPI:1588367247
Name:BUCHANAN, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10123 ROBERT BOST RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-7785
Mailing Address - Country:US
Mailing Address - Phone:980-621-4837
Mailing Address - Fax:
Practice Address - Street 1:10123 ROBERT BOST RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:NC
Practice Address - Zip Code:28107-7785
Practice Address - Country:US
Practice Address - Phone:980-621-4837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician