Individual
IVEETH GABRIELA BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
931 SPRING ST, PLACERVILLE, CA 95667-4543
(530) 621-6104
Mailing address
430 CANAL ST, PLACERVILLE, CA 95667-4346
(530) 622-7022
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Enumeration date
02/09/2007
Last updated
07/08/2007
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