Provider Demographics
NPI:1285111005
Name:BANNER, HEIDI SHELL (DNP, CRNA)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:SHELL
Last Name:BANNER
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:SHARI
Other - Last Name:SHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CRNA
Mailing Address - Street 1:2321 BEAVER OAKS CT.
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-9288
Mailing Address - Country:US
Mailing Address - Phone:336-409-2170
Mailing Address - Fax:
Practice Address - Street 1:3916 BEN FRANKLIN BLVD.
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2383
Practice Address - Country:US
Practice Address - Phone:919-956-9300
Practice Address - Fax:919-595-8454
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202153367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC202153OtherNURSING LICENSE (NC BOARD OF NURSING)