Provider Demographics
NPI:1568018521
Name:EBANKS, CLAUDINE MARSHA (LICENSED NURSE AIDE)
Entity Type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:MARSHA
Last Name:EBANKS
Suffix:
Gender:F
Credentials:LICENSED NURSE AIDE
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:CLAUDINE
Other - Last Name:GAYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED NURSE AIDE
Mailing Address - Street 1:2868 ROUTE 73 N STE 325
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2042
Mailing Address - Country:US
Mailing Address - Phone:914-792-9129
Mailing Address - Fax:
Practice Address - Street 1:2868 ROUTE 73 N STE 325
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2042
Practice Address - Country:US
Practice Address - Phone:914-792-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty