Provider Demographics
NPI:1356557359
Name:BANKS, ANNELLA (CFNP)
Entity type:Individual
Prefix:
First Name:ANNELLA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FIRSTFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1774
Mailing Address - Country:US
Mailing Address - Phone:301-330-4243
Mailing Address - Fax:301-963-9114
Practice Address - Street 1:17 FIRSTFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1774
Practice Address - Country:US
Practice Address - Phone:301-330-4243
Practice Address - Fax:301-963-9114
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR139074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily