Doctor Name: | MRS. VICKIE LYNN BANNISTER |
NPI Number: | 1497736342 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 4704145917 |
Business Practice Address: | 600 N Main St Frankenmuth, MI - 487341152 |
Business Phone Number: | 9896521460 |
Business Fax Number: | 9896521461 |
Mailing Address: | 7480 Baker Rd, FRANKENMUTH |
State: | MI |
Postal Code: | 487349799 |
Phone Number: | 9896521460 |
Fax Number: | 9896521461 |
NPI Enumeration Date: | 11/08/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LX0001X |
License Number: | 4704145917 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Obstetrics & Gynecology |
Taxonomy Definition: |