Provider Demographics
NPI:1134595416
Name:BANKS, REWA A (CNP)
Entity type:Individual
Prefix:
First Name:REWA
Middle Name:A
Last Name:BANKS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2943
Mailing Address - Country:US
Mailing Address - Phone:419-234-2590
Mailing Address - Fax:
Practice Address - Street 1:2895 HARDING HWY STE C
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804
Practice Address - Country:US
Practice Address - Phone:419-222-9828
Practice Address - Fax:567-289-5037
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP19414363LF0000X
OHCNP019414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHATB224079Medicaid