| NPI | 1275994071 |
|---|---|
| Former Name | SUSAN IRENE BANASZAK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9474864) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024173210) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2021-12-02 |