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General NPI Number Information
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NPI Number | 1811964034
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE BANNON APRN
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Gender | Female
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 31 UNION ST
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City | ROCKVILLE
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State | CT
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Zip | 06066-3126
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Country | US
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Telephone | 860-872-5170
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Fax | 860-872-5206
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Provider Business Mailing Address
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Address Line | 54 SAINT MORITZ CIR
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City | WILLINGTON
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State | CT
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Zip | 06279-2210
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Country | US
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Telephone | 860-684-4396
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 002093
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License Number State | CT
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