Provider Demographics
NPI:1477310555
Name:BANUET, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BANUET
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 1:1815 STODDARD ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-1902
Mailing Address - Country:US
Mailing Address - Phone:707-771-9970
Mailing Address - Fax:
Practice Address - Street 1:1815 STODDARD ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-1902
Practice Address - Country:US
Practice Address - Phone:707-771-9970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86102570133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered