Individual
MS. ELLEN MARY BANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
(928) 729-3355
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
(928) 729-3355
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
055-0030836
VT
363A00000X
Physician Assistant
0569
NH
363A00000X
Physician Assistant
Primary
2333
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30334002
—
NH
05
—
518160
—
AZ
05
—
9000244
—
VT
Enumeration date
10/26/2005
Last updated
05/19/2025
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