Provider Demographics
NPI:1205528411
Name:BANKS, RAVEN
Entity type:Individual
Prefix:
First Name:RAVEN
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 1:1235 13TH WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35127-2451
Mailing Address - Country:US
Mailing Address - Phone:205-210-9999
Mailing Address - Fax:
Practice Address - Street 1:1235 13TH WAY
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:AL
Practice Address - Zip Code:35127-2451
Practice Address - Country:US
Practice Address - Phone:205-210-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)