Provider Demographics
NPI:1598478794
Name:BANKS, SHERISA MAE (RN)
Entity Type:Individual
Prefix:
First Name:SHERISA
Middle Name:MAE
Last Name:BANKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44150 W MARICOPA CASA GRANDE HWY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5900
Mailing Address - Country:US
Mailing Address - Phone:520-568-5100
Mailing Address - Fax:
Practice Address - Street 1:43800 W HONEYCUTT RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2545
Practice Address - Country:US
Practice Address - Phone:520-568-6103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ275986163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool