Provider Demographics
NPI:1508259854
Name:BANKS, REBECCA (CPM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21010 SOUTHBANK ST
Mailing Address - Street 2:#2050
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10305 YORKTOWN CT
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-4217
Practice Address - Country:US
Practice Address - Phone:571-438-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000102176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife