Individual
MR. BRIAN KARL O'BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, FNP
Contact information
Practice address
350 S OAK AVE, OAKDALE, CA 95361-3519
(209) 847-3011
Mailing address
PO BOX 10970, WESTMINSTER, CA 92685-0970
(888) 262-9570
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14220
CA
363AM0700X
Medical Physician Assistant
14220
CA
363L00000X
Nurse Practitioner
9179
CA
363LF0000X
Family Nurse Practitioner
9179
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA14220
—
CA
Enumeration date
10/11/2005
Last updated
12/30/2021
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