Basic Information
Provider Information
NPI: 1871101311
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUCHANAN
FirstName: RASHELLE
MiddleName: LERAE
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2650 N TENAYA WAY STE 180
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891281110
CountryCode: US
TelephoneNumber: 7022402952
FaxNumber: 7022430482
Practice Location
Address1: 2650 N TENAYA WAY STE 180
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891281110
CountryCode: US
TelephoneNumber: 7022402952
FaxNumber: 7022430482
Other Information
ProviderEnumerationDate: 07/21/2020
LastUpdateDate: 07/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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