Provider Demographics
NPI:1225458961
Name:BANK, STEPHANIE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BANK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:312-567-6405
Mailing Address - Fax:
Practice Address - Street 1:ST CAMILLUS PALLIATIVE CARE
Practice Address - Street 2:317 ST. FANCIS DRIVE STE 125
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3900
Practice Address - Country:US
Practice Address - Phone:864-255-1304
Practice Address - Fax:864-679-8955
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20737363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5065Medicaid