Individual
LEELAN DIANE BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
510 29 1/2 RD, GRAND JUNCTION, CO 81504-5383
(970) 248-6924
Mailing address
510 29 1/2 RD, GRAND JUNCTION, CO 81504-5383
(970) 248-6924
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
45560
CO
Other
Enumeration date
09/02/2011
Last updated
09/02/2011
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