Provider Demographics
NPI:1396828661
Name:BANNER, MARY FOLEY (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FOLEY
Last Name:BANNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11661 DANE RD
Mailing Address - Street 2:
Mailing Address - City:PILOT POINT
Mailing Address - State:TX
Mailing Address - Zip Code:76258-6574
Mailing Address - Country:US
Mailing Address - Phone:214-675-3136
Mailing Address - Fax:
Practice Address - Street 1:7900 HENNEMAN WAY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2914
Practice Address - Country:US
Practice Address - Phone:214-544-6600
Practice Address - Fax:844-560-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX612631367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS82266Medicare UPIN
TXS82266Medicare UPIN