Provider Demographics
NPI:1013251800
Name:BANNISTER, FARIDA JETHA
Entity type:Individual
Prefix:
First Name:FARIDA
Middle Name:JETHA
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 LYTTONSVILLE RD APT 1007
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1934
Mailing Address - Country:US
Mailing Address - Phone:240-593-7370
Mailing Address - Fax:202-290-3487
Practice Address - Street 1:2445 LYTTONSVILLE RD APT 1007
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1934
Practice Address - Country:US
Practice Address - Phone:240-593-7370
Practice Address - Fax:202-290-3487
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide