Provider Demographics
NPI:1083429054
Name:MUIRHEAD, BANNA JO
Entity type:Individual
Prefix:
First Name:BANNA JO
Middle Name:
Last Name:MUIRHEAD
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 1:600 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:AXTELL
Mailing Address - State:NE
Mailing Address - Zip Code:68924-3408
Mailing Address - Country:US
Mailing Address - Phone:308-440-6333
Mailing Address - Fax:
Practice Address - Street 1:600 W 3RD ST
Practice Address - Street 2:
Practice Address - City:AXTELL
Practice Address - State:NE
Practice Address - Zip Code:68924-3408
Practice Address - Country:US
Practice Address - Phone:308-440-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist