Provider Demographics
NPI:1780943134
Name:BANBURY, JAIME LYNN (RN)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:BANBURY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S HANOVER ST
Mailing Address - Street 2:APT 2
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-2218
Mailing Address - Country:US
Mailing Address - Phone:616-283-2139
Mailing Address - Fax:
Practice Address - Street 1:16 S HANOVER ST
Practice Address - Street 2:APT 2
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-2218
Practice Address - Country:US
Practice Address - Phone:616-283-2139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN635265163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse