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General NPI Number Information
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NPI Number | 1477974095
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Entity Type | Individual
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Provider Name | HENRIETTA BANNERMAN
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Gender | Female
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Dates
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Enumeration Date | 12/27/2013
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 2 UNIVERSITY PLZ
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City | HACKENSACK
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State | NJ
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Zip | 07601-6202
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Country | US
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Telephone | 212-203-1773
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Fax | 646-665-4427
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Provider Business Mailing Address
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Address Line | 274 MADISON AVE RM 1501
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City | NEW YORK
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State | NY
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Zip | 10016-0701
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Country | US
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Telephone | 212-203-1773
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Fax | 646-665-4427
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 678130
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR20490500
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405453
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ14928000
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License Number State | NJ
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