Provider Demographics
NPI:1760927677
Name:MONALISA E BANDA
Entity Type:Organization
Organization Name:MONALISA E BANDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:MONALISA
Authorized Official - Middle Name:EVESS
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-432-5979
Mailing Address - Street 1:2410 HANNAWAY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6803
Mailing Address - Country:US
Mailing Address - Phone:614-432-5879
Mailing Address - Fax:
Practice Address - Street 1:2410 HANNAWAY LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6803
Practice Address - Country:US
Practice Address - Phone:614-432-5879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-31
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========Medicaid