MEDICARE: CHRISTINA BANNISTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN5177978	FL

General Provider Information

NPI Number	:	1629467824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA BANNISTER

Provider Business Mailing Address
First Line	:	1001 N MARTEL AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6611
Country	:	US
Telephone Number	:	323-436-5019
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 ALTON RD
Second Line	:	2ND FLOOR
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-2420
Country	:	US
Telephone Number	:	305-534-4694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/12/2015

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Directions to “ CHRISTINA BANNISTER ” Practice Location

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