Doctor Name: | BRANDI BRIANNE BANNER |
NPI Number: | 1346560976 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT,CMMT,MTI |
License Number: | MT102494 |
Business Practice Address: | 3706 Mockingbird Ln Amarillo, TX - 791093208 |
Business Phone Number: | 8064772111 |
Business Fax Number: | |
Mailing Address: | 4200 Arden Rd, AMARILLO |
State: | TX |
Postal Code: | 791104102 |
Phone Number: | 8064772111 |
Fax Number: | |
NPI Enumeration Date: | 06/05/2010 |
NPI Last Update Date: | 06/05/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MT102494 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |