Provider Demographics
NPI:1164667770
Name:BANKS, LORI DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DENISE
Last Name:BANKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5628 LIEBOLD DR
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3832
Mailing Address - Country:US
Mailing Address - Phone:937-233-6677
Mailing Address - Fax:
Practice Address - Street 1:5628 LIEBOLD DR
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3832
Practice Address - Country:US
Practice Address - Phone:937-233-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130219164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse