Individual
MARY BANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6720 BERTNER AVE, HOUSTON, TX 77030-2604
(832) 355-2666
Mailing address
6501 FANNIN ST STE NC114, HOUSTON, TX 77030-2703
(713) 798-7356
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
647862
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
647862
TX
367500000X
Certified Registered Nurse Anesthetist
AP112241
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166547304
—
TX
01
—
89455U
BCBSTX
TX
Enumeration date
07/07/2006
Last updated
11/16/2022
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