Thank you for your interest in joining the Banner Health Network (BHN). A brief initial interest profile is needed to begin the process. Please complete the questions below and submit.

(* indicates mandatory information)

Please provide the following information

Practice Information

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Contact information

Primary Contact Information

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Credentialing Contact Information

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List New Practitioners Joining Group or All Practitioners If New Practice

Practice Providers Information

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(i.e. MD, DO, DPM, DDS, NP, PA, PhD, etc.)
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Select Banner Facilities * (AT LEAST ONE BOX MUST BE CHECKED)

Facilities

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