Organization
ELIZABETH L BANDA APRN NP-C LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH L BANDA APRN NP-C (SOLE MEMBER)
(918) 721-3955
Entity
Organization
Contact information
Practice address
920 S HIGHWAY 45, BONANZA, AR 72916-3420
(479) 255-6150
Mailing address
112 TEAKWOOD DR, POTEAU, OK 74953-2244
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A004191
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200597420A
—
OK
Enumeration date
04/06/2016
Last updated
04/06/2016
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