1811065881 NPI number — MS. ROHANNA SHEPARD BUCHANAN PHD, QMHP

Table of content: MS. ROHANNA SHEPARD BUCHANAN PHD, QMHP (NPI 1811065881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811065881 NPI number — MS. ROHANNA SHEPARD BUCHANAN PHD, QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCHANAN
Provider First Name:
ROHANNA
Provider Middle Name:
SHEPARD
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD, QMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811065881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 SHELTON MCMURPHEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-4928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-485-2711
Provider Business Mailing Address Fax Number:
815-550-1789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 SHELTON MCMURPHEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-4928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-485-2711
Provider Business Practice Location Address Fax Number:
815-550-1789
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500691953 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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