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General NPI Number Information
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NPI Number | 1427325638
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Entity Type | Individual
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Provider Name | JEANETTE C. BANNISTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 13677 W MCDOWELL RD
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City | GOODYEAR
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State | AZ
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Zip | 85395-2635
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Country | US
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Telephone | 623-536-4200
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Fax | 623-935-0304
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Provider Business Mailing Address
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Address Line | 9250 N 3RD ST STE 3015
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City | PHOENIX
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State | AZ
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Zip | 85020-2425
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Country | US
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Telephone | 602-996-4747
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Fax | 602-953-5466
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10001343A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5411
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License Number State | AZ
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