Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 5200 | AZ |
NPI | 1114271798 |
---|---|
Provider Name | Kristen Marie Buchanan |
First Address | Peoria, AZ 85382 |
Second Address | Phoenix, AZ 85031-1237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2012 |
Last Update Date | 15/07/2021 |