Individual
MS. MARITA CHAN BANISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 S SIDE BLVD, GREENSBORO, NC 27406-3311
(336) 604-2317
Mailing address
2401 S SIDE BLVD, GREENSBORO, NC 27406-3311
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
134372
NC
Other
Enumeration date
01/25/2024
Last updated
01/25/2024
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