Provider Demographics
NPI:1932494895
Name:BANNISTER, YVONNE (BS, IBCLC, CBE, CMT,)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:BS, IBCLC, CBE, CMT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CORIANDER AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2536
Mailing Address - Country:US
Mailing Address - Phone:831-636-6781
Mailing Address - Fax:
Practice Address - Street 1:131 CORIANDER AVE
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2536
Practice Address - Country:US
Practice Address - Phone:831-636-6781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197-13766174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197-13766OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS