Provider Demographics
NPI:1851052260
Name:EBANKS, AMORIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:AMORIE
Middle Name:
Last Name:EBANKS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 EDGEWARE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4216
Mailing Address - Country:US
Mailing Address - Phone:301-379-4582
Mailing Address - Fax:
Practice Address - Street 1:2109 EDGEWARE ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-4216
Practice Address - Country:US
Practice Address - Phone:301-379-4582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185016163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse