Doctor Name: | JENNY BANACH |
NPI Number: | 1417346057 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | RN2279771 |
Business Practice Address: | 131 Emerald St Wrentham, MA - 020931902 |
Business Phone Number: | 5083843114 |
Business Fax Number: | |
Mailing Address: | 131 Emerald St, WRENTHAM |
State: | MA |
Postal Code: | 020931902 |
Phone Number: | 5083843114 |
Fax Number: | |
NPI Enumeration Date: | 01/20/2015 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | RN2279771 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |