Provider Demographics
NPI:1104151398
Name:RNFA4U,PLLC
Entity type:Organization
Organization Name:RNFA4U,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BANASIAK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:281-948-4945
Mailing Address - Street 1:22906 E FAIRFAX VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-5003
Mailing Address - Country:US
Mailing Address - Phone:281-948-4945
Mailing Address - Fax:
Practice Address - Street 1:22906 E FAIRFAX VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-5003
Practice Address - Country:US
Practice Address - Phone:281-948-4945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
364SM0705X
TX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-SurgicalGroup - Single Specialty