Provider Demographics
NPI:1265930127
Name:BANYS, OLGA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:BANYS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:VOLHA
Other - Middle Name:
Other - Last Name:HLAVATSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10S432 ECHO LN APT 3
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6798
Mailing Address - Country:US
Mailing Address - Phone:347-416-1610
Mailing Address - Fax:
Practice Address - Street 1:350 N WALL ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2901
Practice Address - Country:US
Practice Address - Phone:815-935-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-006493363A00000X
IL085006493363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant