Provider Demographics
NPI:1477055127
Name:BANUS, KAY GRITZKE
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:GRITZKE
Last Name:BANUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15303 HUEBNER RD STE 15
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-0983
Mailing Address - Country:US
Mailing Address - Phone:210-646-1570
Mailing Address - Fax:210-697-2401
Practice Address - Street 1:15303 HUEBNER RD STE 15
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0983
Practice Address - Country:US
Practice Address - Phone:210-646-1570
Practice Address - Fax:210-697-2401
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-16156174N00000X
TX618778163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN