Individual
MRS. JEANETTE C. BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13677 W MCDOWELL RD, GOODYEAR, AZ 85395-2635
(623) 536-4200
(623) 935-0304
Mailing address
9250 N 3RD ST STE 3015, PHOENIX, AZ 85020-2425
(602) 996-4747
(602) 953-5466
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10001343A
IN
363A00000X
Physician Assistant
Primary
5411
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
827411
—
AZ
Enumeration date
11/17/2011
Last updated
07/21/2022
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