Provider Demographics
NPI:1437895232
Name:BANKSTON, ANNMARIE FUSCO (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:FUSCO
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NC
Mailing Address - Zip Code:28127-8734
Mailing Address - Country:US
Mailing Address - Phone:607-621-0177
Mailing Address - Fax:
Practice Address - Street 1:507 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2709
Practice Address - Country:US
Practice Address - Phone:910-576-0042
Practice Address - Fax:910-576-1442
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily