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General NPI Number Information
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NPI Number | 1184548828
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Entity Type | Organization
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Legal Business Name | BANNER WELLNESS PLLC
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 6060 DILBECK LN
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City | DALLAS
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State | TX
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Zip | 75240-5351
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Country | US
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Telephone | 972-385-3643
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Fax | 240-923-7090
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Provider Business Mailing Address
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Address Line | 6060 DILBECK LN
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City | DALLAS
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State | TX
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Zip | 75240-5351
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Country | US
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Telephone | 972-385-3643
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Fax | 240-923-7090
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Authorized Official
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Title or Position | BILLING ADMINISTRATOR
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Name | GRISELDA HERNANDEZ
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Credential |
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Telephone | 817-845-5622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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