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General NPI Number Information
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NPI Number | 1598482580
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Entity Type | Individual
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Provider Name | TYRONE O'BANNER
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Gender | Male
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Dates
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Enumeration Date | 10/20/2022
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 417 LIBERTY ST
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City | SPRINGFIELD
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State | MA
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Zip | 01104-3736
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Country | US
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Telephone | 413-301-9355
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6768
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City | HOLYOKE
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State | MA
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Zip | 01041-6768
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Country | US
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Telephone | 413-218-4888
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN10003790
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN2345699
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License Number State | MA
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