Individual
JENNY BANACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
131 EMERALD ST, WRENTHAM, MA 02093-1902
(508) 384-3114
Mailing address
131 EMERALD ST, WRENTHAM, MA 02093-1902
(508) 384-3114
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
RN2279771
MA
Other
Enumeration date
01/20/2015
Last updated
01/20/2015
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