Provider Demographics
NPI:1104123371
Name:BANISTER, ANNA LEE (ANP-BC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LEE
Last Name:BANISTER
Suffix:
Gender:F
Credentials:ANP-BC
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 386
Mailing Address - Street 2:1259 HYW 119S
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-0386
Mailing Address - Country:US
Mailing Address - Phone:912-754-6451
Mailing Address - Fax:
Practice Address - Street 1:800 TOWNE PARK DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5156
Practice Address - Country:US
Practice Address - Phone:912-826-0052
Practice Address - Fax:912-826-4726
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144607363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health