Healthcare Provider Details

I. General information

NPI: 1184927048
Provider Name (Legal Business Name): LESLIE ANNE BANNING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BLUE PKWY
KANSAS CITY MO
64130-2807
US

IV. Provider business mailing address

3801 BLUE PKWY
KANSAS CITY MO
64130-2807
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-3166
  • Fax: 816-448-2937
Mailing address:
  • Phone: 816-922-3166
  • Fax: 816-448-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number2007035873
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: