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General NPI Number Information
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NPI Number | 1629467824
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Entity Type | Individual
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Provider Name | CHRISTINA BANNISTER
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Gender | Female
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 1613 ALTON RD 2ND FLOOR
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City | MIAMI BEACH
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State | FL
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Zip | 33139-2420
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Country | US
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Telephone | 305-534-4694
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 N MARTEL AVE
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-6611
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Country | US
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Telephone | 323-436-5019
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5177978
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License Number State | FL
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