Individual
JILL A. BANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 432-2297
(260) 434-6433
Mailing address
6920 POINTE INVERNESS WAY STE 200, MEDPARTNERS, ATTN: BARB COPELAND, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000588A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000289311
ANTHEM
IN
05
—
200321220
—
IN
05
—
2454320
—
OH
01
—
500016208
RAILROAD
—
Enumeration date
03/02/2006
Last updated
12/18/2016
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