1891131629 NPI number — MRS. COURTNEY LYNN BANAS M.A.

Table of content: MRS. COURTNEY LYNN BANAS M.A. (NPI 1891131629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891131629 NPI number — MRS. COURTNEY LYNN BANAS M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANAS
Provider First Name:
COURTNEY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOHL
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891131629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59 LINCOLN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENMORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14217-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-628-4062
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 STAHL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GETZVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14068-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-629-3400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)