Provider Demographics
NPI:1679918692
Name:BANKS, IRIELLE L (FNP)
Entity Type:Individual
Prefix:MISS
First Name:IRIELLE
Middle Name:L
Last Name:BANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-2008
Mailing Address - Country:US
Mailing Address - Phone:504-621-7041
Mailing Address - Fax:
Practice Address - Street 1:1401 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-842-4747
Practice Address - Fax:504-842-1242
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA122898-7291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1679918692Medicaid