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General NPI Number Information
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NPI Number | 1487211827
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Entity Type | Individual
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Provider Name | MISS TEONDRA BANNERMAN
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 318 S SYCAMORE ST
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City | ROSE HILL
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State | NC
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Zip | 28458
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Country | US
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Telephone | 910-447-2509
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 312
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City | ROSE HILL
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State | NC
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Zip | 28458-0312
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Country | US
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Telephone | 910-379-5707
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CADC-26186
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State | NC
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