Individual
JUDY BANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3330 NW 56TH ST, SUITE 400, OKLAHOMA CITY, OK 73112-4479
(405) 945-4220
Mailing address
1400 REDBUD HOLW, EDMOND, OK 73034-9714
(405) 562-0213
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R62457
OK
Other
Enumeration date
08/27/2012
Last updated
08/27/2012
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