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General NPI Number Information
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NPI Number | 1033763537
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Entity Type | Individual
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Provider Name | DALLAS BANNER NP
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Gender | Female
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 3000 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1231
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Country | US
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Telephone | 919-350-8114
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Fax |
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Provider Business Mailing Address
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Address Line | 5115 PARK RD APT 302
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City | CHARLOTTE
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State | NC
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Zip | 28209-3820
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WU0100X
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Taxonomy Name | Urology Registered Nurse
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License Number | 259156
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 5012314
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5012314
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License Number State | NC
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