Individual
GWENDOLYN BANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN655020
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A2634637
DRIVER LICENSE
CA
Enumeration date
06/07/2018
Last updated
04/05/2019
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