Provider Demographics
NPI:1538886346
Name:BANNISTER, JACQUELINE LORRAINE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LORRAINE
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:LORRAINE
Other - Last Name:BANNISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7531 CUTTERS EDGE CT APT H
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8960
Mailing Address - Country:US
Mailing Address - Phone:614-264-0641
Mailing Address - Fax:
Practice Address - Street 1:7531 CUTTERS EDGE CT APT H
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8960
Practice Address - Country:US
Practice Address - Phone:614-264-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care