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General NPI Number Information
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NPI Number | 1699256636
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Entity Type | Individual
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Provider Name | JOBEN SAMSON BANAN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 2235 S GOLIAD ST STE 110
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City | ROCKWALL
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State | TX
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Zip | 75032-4903
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Country | US
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Telephone | 469-495-9142
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Fax |
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Provider Business Mailing Address
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Address Line | 7609 AMESBURY LN
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City | ROWLETT
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State | TX
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Zip | 75089-3881
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP137884
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License Number State | TX
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