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General NPI Number Information
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NPI Number | 1376765206
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Entity Type | Individual
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Provider Name | SHERI LYNNE BANOVIC FNP
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 115 SOUTH MACOUPIN STREET
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City | GILLESPIE
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State | IL
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Zip | 62033
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Country | US
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Telephone | 217-839-1526
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Fax |
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Provider Business Mailing Address
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Address Line | 520 EAST LEONARD
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City | STAUNTON
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State | IL
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Zip | 62088-1235
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Country | US
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Telephone | 618-468-4433
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | IL
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