Healthcare Provider Details

I. General information

NPI: 1801076948
Provider Name (Legal Business Name): GINGER RHEA BANE RN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BUILDING 2, SUITE 300
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

2200 PARK BEND DR BUILDING 2, SUITE 300
AUSTIN TX
78758-5387
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-5665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number746991
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: