Provider Demographics
NPI:1598815656
Name:BANATTE-VICTOR, ANNETTE J (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:J
Last Name:BANATTE-VICTOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5892 CRISFIELD HIGHWAY
Mailing Address - Street 2:PO BOX 156
Mailing Address - City:MARION
Mailing Address - State:MD
Mailing Address - Zip Code:21838-0156
Mailing Address - Country:US
Mailing Address - Phone:410-623-2528
Mailing Address - Fax:
Practice Address - Street 1:5892 CRISFIELD HIGHWAY
Practice Address - Street 2:5892 CRISFIELD HIGHWAY
Practice Address - City:MARION
Practice Address - State:MD
Practice Address - Zip Code:21838-0156
Practice Address - Country:US
Practice Address - Phone:410-623-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR109266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily