Provider Demographics
NPI:1477012136
Name:BANKS-COOPER, TANISHA (LPN)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:BANKS-COOPER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 N MALLORY ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-1460
Mailing Address - Country:US
Mailing Address - Phone:757-254-6026
Mailing Address - Fax:
Practice Address - Street 1:1203 N MALLORY ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-1460
Practice Address - Country:US
Practice Address - Phone:757-254-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002086984164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse