Provider Demographics
NPI:1568125037
Name:BANKS, PRECIOUS DANIELLE (LPN)
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:DANIELLE
Last Name:BANKS
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 1:205 W JASPER ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENS
Mailing Address - State:AR
Mailing Address - Zip Code:71764-8342
Mailing Address - Country:US
Mailing Address - Phone:870-807-4606
Mailing Address - Fax:
Practice Address - Street 1:205 W JASPER ST
Practice Address - Street 2:
Practice Address - City:STEPHENS
Practice Address - State:AR
Practice Address - Zip Code:71764-8342
Practice Address - Country:US
Practice Address - Phone:870-807-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217074164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty