Provider Demographics
NPI:1457156317
Name:JARJU, BANNA
Entity type:Individual
Prefix:
First Name:BANNA
Middle Name:
Last Name:JARJU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5343 ANSBACH DR
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-3507
Mailing Address - Country:US
Mailing Address - Phone:929-228-6775
Mailing Address - Fax:
Practice Address - Street 1:5343 ANSBACH DR
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-3507
Practice Address - Country:US
Practice Address - Phone:929-228-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY515293374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide