Basic Information
| Provider Information | |||||||||
| NPI: | 1477611820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANNING | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | JEANNINE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6399 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719026399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016205130 | ||||||||
| FaxNumber: | 5016205203 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 SOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719133423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016205139 | ||||||||
| FaxNumber: | 5016205109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | R77811 | AR | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.