Provider Demographics
NPI:1922139369
Name:BANKS, CLAIRE LYN (RD LD CDE)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:LYN
Last Name:BANKS
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:MS
Other - First Name:CLAIRE
Other - Middle Name:LYN
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD CDE
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-1337
Mailing Address - Country:US
Mailing Address - Phone:505-722-1000
Mailing Address - Fax:505-722-1496
Practice Address - Street 1:516 EAST NIZHONI BLVD.
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:505-722-1496
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD519133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP60480Medicare UPIN