MEDICARE: MONALISA E BANDA

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1760927677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONALISA E BANDA

Provider Business Mailing Address
First Line	:	2410 HANNAWAY LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-6803
Country	:	US
Telephone Number	:	614-432-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 HANNAWAY LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-6803
Country	:	US
Telephone Number	:	614-432-5879
Fax Number	:

Authorized Official
Title or Position	:	LPN
Name	:	MONALISA EVESS BANDA
Credential	:
Telephone Number	:	614-432-5979

Provider Enumeration Date	:	12/31/2016
Last Update Date	:	12/31/2016

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