Individual
MRS. CAROL ANN BANISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
4200 W MEMORIAL RD, SUITE 701, OKLAHOMA CITY, OK 73120-9350
(405) 755-7561
(405) 755-7615
Mailing address
2120 WOODHILL RD, EDMOND, OK 73003-2930
(405) 349-0063
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
251
OK
Other
Enumeration date
07/09/2006
Last updated
07/08/2007
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