Individual provider · NPI-1

Shawn Banner

Home Health · Fort Pierce, FL

NPI number1225791908
StatusActive
Last updated in NPPESOct 19, 2021

Details

NPI
1225791908
Entity type
Individual (NPI-1)
Name
Shawn Banner
Sex
Male
Sole proprietor
Yes
Enumeration date
Oct 19, 2021
Certification date
Oct 19, 2021
Last updated
Oct 19, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251E00000X Home Health––Yes

Practice location

165 Carol Susan Ln
Fort Pierce, FL 34982-8340

Phone 772-206-5815

Mailing address

165 Carol Susan Ln
Fort Pierce, FL 34982-8340

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