Provider Demographics
NPI:1376393231
Name:BANKS, GENELL FA'TEMA-ROCHEA
Entity Type:Individual
Prefix:
First Name:GENELL
Middle Name:FA'TEMA-ROCHEA
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26271 W HILLS DR
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1906
Mailing Address - Country:US
Mailing Address - Phone:313-675-7484
Mailing Address - Fax:
Practice Address - Street 1:3799 HENRY RUFF RD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2071
Practice Address - Country:US
Practice Address - Phone:313-675-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide