Provider Demographics
NPI:1407316078
Name:BANKS, NICKOLE
Entity Type:Individual
Prefix:
First Name:NICKOLE
Middle Name:
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 1:2114 FRERET ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-2402
Mailing Address - Country:US
Mailing Address - Phone:504-344-7864
Mailing Address - Fax:504-264-7265
Practice Address - Street 1:2114 FRERET ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-2402
Practice Address - Country:US
Practice Address - Phone:504-344-7864
Practice Address - Fax:504-264-7265
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-0318467OtherBUSINESS