Individual
NICOLE MARIE BANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
100 CHESTNUT AVE, ALTOONA, PA 16601-4926
(814) 201-5266
(272) 200-0242
Mailing address
1905 4TH AVE, ALTOONA, PA 16602-2341
(814) 414-6240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP024461
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004984455
HIGHMARK BCBS
PA
Enumeration date
05/06/2022
Last updated
02/07/2023
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