Provider Demographics
NPI:1992168207
Name:BUCHANAN, LASHAWN
Entity type:Individual
Prefix:
First Name:LASHAWN
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 S PRIEUR ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-3835
Mailing Address - Country:US
Mailing Address - Phone:504-278-0345
Mailing Address - Fax:504-304-0600
Practice Address - Street 1:2805 S PRIEUR ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-3835
Practice Address - Country:US
Practice Address - Phone:504-278-0345
Practice Address - Fax:504-304-0600
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006251406343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA81-1752197OtherFEDERAL TAX