Provider Demographics
NPI:1659430684
Name:BANKER, BRENDA LOU (ARNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOU
Last Name:BANKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 180TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-8820
Mailing Address - Country:US
Mailing Address - Phone:563-212-8907
Mailing Address - Fax:
Practice Address - Street 1:2635 LINCOLN WAY
Practice Address - Street 2:SUITE A
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7203
Practice Address - Country:US
Practice Address - Phone:563-241-1328
Practice Address - Fax:563-242-9992
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA068989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421116446OtherWOMEN'S HEALTH SERVICES TAX ID