Individual
CLINTON DALE BANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
500 SW RAMSEY, GRANTS PASS, OR 97527
(541) 472-7069
Mailing address
PO BOX 338, 133 WINNIE WALKER LANE, GLENDALE, OR 97442-0338
(541) 832-2335
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2001141562RN
OR
363LF0000X
Family Nurse Practitioner
Primary
201050003NP
OR
Other
Enumeration date
12/24/2009
Last updated
02/11/2010
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