Individual
MRS. MAGGIE FORD BANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2206 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 517-8627
(434) 517-8080
Mailing address
2206 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 517-8627
(434) 517-8080
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0024170022
VA
363LA2200X
Adult Health Nurse Practitioner
5005825
NC
Other
Enumeration date
04/25/2012
Last updated
09/15/2020
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