Provider Demographics
NPI:1396871372
Name:BANYAS, PAMELA SUE (PA-C)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:BANYAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10611 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3731
Mailing Address - Country:US
Mailing Address - Phone:515-254-2265
Mailing Address - Fax:515-254-2272
Practice Address - Street 1:10611 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-3731
Practice Address - Country:US
Practice Address - Phone:515-254-2265
Practice Address - Fax:515-254-2272
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15138Medicare ID - Type Unspecified