=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659430684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA LOU BANKER ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 07/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2635 LINCOLN WAY SUITE A
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52732-7203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-241-1328
-----------------------------------------------------
Fax | 563-242-9992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4331 180TH ST
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52732-8820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-212-8907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | A068989
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------