Provider Demographics
NPI:1609677855
Name:BANNO, TAMILYN (LAC)
Entity type:Individual
Prefix:
First Name:TAMILYN
Middle Name:
Last Name:BANNO
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 N ORACLE RD APT 189
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6452
Mailing Address - Country:US
Mailing Address - Phone:309-397-4193
Mailing Address - Fax:
Practice Address - Street 1:8215 N ORACLE RD APT 189
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6452
Practice Address - Country:US
Practice Address - Phone:309-397-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001507171100000X
AZ012207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist