Provider Demographics
NPI:1689376113
Name:BANKS, CLINISHA
Entity Type:Individual
Prefix:
First Name:CLINISHA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 GARDEN VALLEY AVE APT 35
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-4268
Mailing Address - Country:US
Mailing Address - Phone:216-320-7717
Mailing Address - Fax:
Practice Address - Street 1:7055 GARDEN VALLEY AVE APT 35
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-4268
Practice Address - Country:US
Practice Address - Phone:216-320-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide