Provider Demographics
NPI:1356052146
Name:BANNER, KAREN
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:BANNER
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:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:LARIMORE
Mailing Address - State:ND
Mailing Address - Zip Code:58251-0113
Mailing Address - Country:US
Mailing Address - Phone:701-330-5238
Mailing Address - Fax:
Practice Address - Street 1:1395 47TH ST NE
Practice Address - Street 2:
Practice Address - City:LARIMORE
Practice Address - State:ND
Practice Address - Zip Code:58251-9600
Practice Address - Country:US
Practice Address - Phone:701-230-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant