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Individual
KENNETH BANGS
Active
Individual
KENNETH BANGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10049
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0170299
STATE OF WASHINGTON
CA
01
—
500030488
RAIL ROAD MEDICARE
CA
Enumeration date
11/15/2005
Last updated
09/09/2015
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