Provider Demographics
NPI:1811697253
Name:BANAHENE, PHYLLIS AGOVI (RN)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:AGOVI
Last Name:BANAHENE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WATSON LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9389
Mailing Address - Country:US
Mailing Address - Phone:302-668-9851
Mailing Address - Fax:
Practice Address - Street 1:34 WATSON LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-9389
Practice Address - Country:US
Practice Address - Phone:302-668-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0034161163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis