Healthcare Provider Details

I. General information

NPI: 1699969592
Provider Name (Legal Business Name): MARY JANE BANWELL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

3737 N COUNTRY CLUB RD # 202SOUTH
TUCSON AZ
85716-1232
US

V. Phone/Fax

Practice location:
  • Phone: 520-629-4607
  • Fax:
Mailing address:
  • Phone: 520-327-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: