Individual
JEAN M BANVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1228 ELM ST, MANCHESTER, NH 03101-1349
(603) 668-4111
Mailing address
401 CYPRESS ST, MANCHESTER, NH 03103-3628
(603) 668-4111
(603) 628-7757
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
021072-21
NH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
051072-23
NH
Other
Enumeration date
11/02/2007
Last updated
11/08/2007
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