Individual
MS. LORANDA LEE BANKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,RD,LDN
Contact information
Practice address
623 N MAIN ST, FLORA, IL 62839-1407
(618) 676-5748
Mailing address
623 N MAIN ST, FLORA, IL 62839-1407
(618) 676-5748
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.003241
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K23388
MEDICARE PART B PROVIDER
IL
Enumeration date
09/30/2013
Last updated
09/30/2013
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