Provider Demographics
NPI:1710616867
Name:BANKSTON, BRITTNEY ANN (BAS)
Entity Type:Individual
Prefix:MISS
First Name:BRITTNEY
Middle Name:ANN
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:BAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 W FOND DU LAC AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5600
Mailing Address - Country:US
Mailing Address - Phone:414-930-0072
Mailing Address - Fax:414-930-8001
Practice Address - Street 1:6150 W FOND DU LAC AVE STE 201
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5600
Practice Address - Country:US
Practice Address - Phone:414-930-0072
Practice Address - Fax:414-930-8001
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program