Provider Demographics
NPI:1821416942
Name:BANNISTER-HAWKINS, AMBER (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:BANNISTER-HAWKINS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 LEDRO ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2628
Mailing Address - Country:US
Mailing Address - Phone:513-432-2196
Mailing Address - Fax:
Practice Address - Street 1:868 LEDRO ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2628
Practice Address - Country:US
Practice Address - Phone:513-432-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.145014-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse