Provider Demographics
NPI:1366413593
Name:BANNER, RANDI (CRNP)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:BANNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1382 NEWTOWN LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2401
Mailing Address - Country:US
Mailing Address - Phone:215-504-6809
Mailing Address - Fax:215-579-0266
Practice Address - Street 1:1382 NEWTOWN LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-2401
Practice Address - Country:US
Practice Address - Phone:215-504-6809
Practice Address - Fax:215-579-0266
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAUP005559B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ36069Medicare UPIN