Provider Demographics
NPI:1902041049
Name:BUCHANAN, AVIS CAROL (MSN, BC)
Entity Type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:CAROL
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MSN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RAINSBOROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8870
Mailing Address - Country:US
Mailing Address - Phone:803-419-9343
Mailing Address - Fax:803-898-4899
Practice Address - Street 1:2414 BULL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1906
Practice Address - Country:US
Practice Address - Phone:803-898-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31238163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator