Individual
MRS. CARLA ELIZABETH BANONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10 NOSTRAND AVE, SELDEN, NY 11784
(631) 846-1616
Mailing address
10 NOSTRAND AVE, SELDEN, NY 11784-1008
(631) 846-1616
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
238876-1
NY
Other
Enumeration date
09/07/2007
Last updated
09/07/2007
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