Provider Demographics
NPI:1841789807
Name:BANNING, CHLOE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:BANNING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5320
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-5320
Mailing Address - Country:US
Mailing Address - Phone:970-766-3223
Mailing Address - Fax:
Practice Address - Street 1:6460 MEDICAL CENTER ST STE 350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2423
Practice Address - Country:US
Practice Address - Phone:702-255-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-05
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant