Provider Demographics
NPI:1316291933
Name:BANYA, EMMA SOMBO (CRNA)
Entity type:Individual
Prefix:MISS
First Name:EMMA
Middle Name:SOMBO
Last Name:BANYA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 3 GENERAL DELIVERY
Mailing Address - Street 2:694 A STREET, TRAVIS AIRFORCE BASE
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:94535-5414
Mailing Address - Country:US
Mailing Address - Phone:240-475-4984
Mailing Address - Fax:
Practice Address - Street 1:PSC 3 GENERAL DELIVERY
Practice Address - Street 2:694 A STREET, TRAVIS AIRFORCE BASE
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:94535-5414
Practice Address - Country:US
Practice Address - Phone:707-372-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR127245163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse