Provider Demographics
NPI:1437107018
Name:BANNISTER, DARLA ANN (NURSE PRACTIONER)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:ANN
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3265
Mailing Address - Country:US
Mailing Address - Phone:505-885-2188
Mailing Address - Fax:505-885-2188
Practice Address - Street 1:2411 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3265
Practice Address - Country:US
Practice Address - Phone:505-885-2188
Practice Address - Fax:505-885-6486
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR33645363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH5181Medicaid
NMH5181Medicaid