Provider Demographics
NPI:1043107691
Name:BUCHANAN, BRYAN THOMAS
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:THOMAS
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 1:8148 SANBORN DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2024
Mailing Address - Country:US
Mailing Address - Phone:602-706-5162
Mailing Address - Fax:
Practice Address - Street 1:8148 SANBORN DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2024
Practice Address - Country:US
Practice Address - Phone:602-706-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE05783313101372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion