Provider Demographics
NPI:1477931384
Name:BANASIK, STEPHANIE EILEEN (ADULT NURSE PRACTITI)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:EILEEN
Last Name:BANASIK
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
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Mailing Address - Street 1:1175 COOK RD
Mailing Address - Street 2:STE 115
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-8201
Mailing Address - Country:US
Mailing Address - Phone:803-531-2677
Mailing Address - Fax:803-531-6137
Practice Address - Street 1:10200 FORD AVE. STE. 101
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-459-6446
Practice Address - Fax:912-445-5781
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2016-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN220937363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner