Provider Demographics
NPI:1265869671
Name:BANKER, LORANDA LEE (MS,RD,LDN)
Entity type:Individual
Prefix:MS
First Name:LORANDA
Middle Name:LEE
Last Name:BANKER
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-1407
Mailing Address - Country:US
Mailing Address - Phone:618-676-5748
Mailing Address - Fax:
Practice Address - Street 1:623 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-1407
Practice Address - Country:US
Practice Address - Phone:618-676-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.003241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23388OtherMEDICARE PART B PROVIDER