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General NPI Number Information
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NPI Number | 1528706553
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Entity Type | Individual
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Provider Name | JANUKA BANJARA
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Gender | Female
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Dates
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Enumeration Date | 05/20/2022
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 8402 CROSS PARK DR
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City | AUSTIN
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State | TX
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Zip | 78754-4595
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Country | US
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Telephone | 512-840-1158
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Fax |
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Provider Business Mailing Address
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Address Line | 208 BELLA COLINAS DR
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City | AUSTIN
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State | TX
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Zip | 78738-7631
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Country | US
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Telephone | 512-840-1158
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Fax | 512-777-5974
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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 | 1079277
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License Number State | TX
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