| NPI | 1316255979 |
|---|---|
| Former Name | CAROL BANACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP012103) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN575054) |
| 163W00000X Registered Nurse (Licence: NJ 26NR13660700) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP010720) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00376100) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2012-06-06 |