Provider Demographics
NPI:1710795471
Name:BANEY, MCKINZIE (CNA)
Entity type:Individual
Prefix:
First Name:MCKINZIE
Middle Name:
Last Name:BANEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BENKELMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69021-3014
Mailing Address - Country:US
Mailing Address - Phone:308-414-2241
Mailing Address - Fax:
Practice Address - Street 1:947 FREMONT ST
Practice Address - Street 2:
Practice Address - City:BENKELMAN
Practice Address - State:NE
Practice Address - Zip Code:69021-3014
Practice Address - Country:US
Practice Address - Phone:308-414-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE154052376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide