Basic Information
| Provider Information | |||||||||
| NPI: | 1578158101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANICHAR | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | JOI | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 ABERCORN ST | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310886782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787965731 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1707 WATSON BLVD | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310933606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789298030 | ||||||||
| FaxNumber: | 4789298095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2021 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | RN233561 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.