Provider Demographics
NPI:1699920298
Name:BANTHER, ANNE ELIZABETH (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:BANTHER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-9558
Mailing Address - Country:US
Mailing Address - Phone:405-249-9751
Mailing Address - Fax:405-375-3634
Practice Address - Street 1:137 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-9558
Practice Address - Country:US
Practice Address - Phone:405-249-9751
Practice Address - Fax:405-375-3634
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0071326163WL0100X
OK106-22816163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant