Healthcare Provider Details

I. General information

NPI: 1649189093
Provider Name (Legal Business Name): ALLAN NATHANIEL BANE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2086 VISTA MAR DR
EL DORADO HILLS CA
95762-3716
US

IV. Provider business mailing address

2086 VISTA MAR DR
EL DORADO HILLS CA
95762-3716
US

V. Phone/Fax

Practice location:
  • Phone: 707-305-9481
  • Fax:
Mailing address:
  • Phone: 707-305-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number905104
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: