Provider Demographics
NPI:1477069672
Name:BANKS, COURTNEY VICTORIA
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:VICTORIA
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 1:7244 EARLY GOLDEN LN
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5855
Mailing Address - Country:US
Mailing Address - Phone:443-360-7323
Mailing Address - Fax:
Practice Address - Street 1:8630 FENTON ST STE 1204
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3808
Practice Address - Country:US
Practice Address - Phone:301-340-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily