Provider Demographics
NPI:1275272254
Name:BANKS, MACKENNA MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:MACKENNA
Middle Name:MARIE
Last Name:BANKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MACKENNA
Other - Middle Name:MARIE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1824 GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-732-8877
Mailing Address - Fax:
Practice Address - Street 1:1824 GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1233
Practice Address - Country:US
Practice Address - Phone:717-732-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026093363LF0000X
PAPURSUING363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily