Basic Information
| Provider Information | |||||||||
| NPI: | 1861022279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANKER | ||||||||
| FirstName: | LACI | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22995 STATE HWY 60 | ||||||||
| Address2: | |||||||||
| City: | MUSCODA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535735592 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | RICHLAND CENTER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535811914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086476321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2020 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.