Individual
KENNETH MICHAEL BANIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18701 N 67TH AVE, GLENDALE, AZ 85308-7100
(623) 561-1000
Mailing address
7809 N 21ST LN, PHOENIX, AZ 85021-4947
(360) 202-5684
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
217666
MT
367500000X
Certified Registered Nurse Anesthetist
Primary
267210
AZ
Other
Enumeration date
11/30/2021
Last updated
09/07/2023
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