Amy Bannerman, PHLEBOTOMIST
Individual provider Active NPI Pathology Specialist/Technologist · Wallace, NC
NPI 1104771450 · NPPES record last updated Mar 2, 2026
Key facts
- NPI
- 1104771450
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pathology Specialist/Technologist 246Q00000X
- License
- Y2G5T7L7 (NC)
- Practice address
- 133 Glendale Village LN
Wallace, NC 28466-1637 - Phone
- (910) 787-6633
- NPI assigned
- Mar 2, 2026
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Y2G5T7L7 | NC | MD | Pathology Specialist/Technologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pathology Specialist/Technologist | 246Q00000X | Y2G5T7L7 | NC | Yes |
Addresses
Primary practice location
133 Glendale Village LN
Wallace, NC 28466-1637
Mailing address
133 Glendale Village LN
Wallace, NC 28466-1637
Phone (910) 787-6633
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All providers in Wallace, NC · Pathology Specialist/Technologist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.