Individual
ELIZABETH BANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
500 S BROADWAY ST, STE B, POTEAU, OK 74953-3819
(918) 208-7497
(918) 208-7687
Mailing address
500 S BROADWAY ST, STE B, POTEAU, OK 74953-3819
(918) 208-7497
(918) 208-7687
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
74771
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200597420A
—
OK
Enumeration date
06/20/2014
Last updated
02/16/2017
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