Healthcare Provider Details

I. General information

NPI: 1326211533
Provider Name (Legal Business Name): ADAM S BANASIAK R.N, C.N.O.R, RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27111 ROSE VERVAIN DR
SPRING TX
77386-3948
US

IV. Provider business mailing address

9450 PINECROFT DR # 8691
SPRING TX
77380-3220
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number699010
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: