Provider Demographics
NPI:1780676007
Name:O'BANNON, ANNA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:O'BANNON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 E GERONIMO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2339
Mailing Address - Country:US
Mailing Address - Phone:480-699-2757
Mailing Address - Fax:480-699-2757
Practice Address - Street 1:2390 E GERONIMO ST
Practice Address - Street 2:INTEGRITY HEALTHCARE CONNECTION, PLLC
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2339
Practice Address - Country:US
Practice Address - Phone:480-699-2757
Practice Address - Fax:480-699-2757
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 1083 ; RN 060080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P80086Medicare UPIN