Provider Demographics
NPI:1750527271
Name:BANKS, SHARLENE CAROL (MSN,CNS)
Entity type:Individual
Prefix:
First Name:SHARLENE
Middle Name:CAROL
Last Name:BANKS
Suffix:
Gender:F
Credentials:MSN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-0475
Mailing Address - Country:US
Mailing Address - Phone:812-346-2872
Mailing Address - Fax:812-346-4172
Practice Address - Street 1:257 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1510
Practice Address - Country:US
Practice Address - Phone:812-346-2872
Practice Address - Fax:812-346-4172
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28058096A364SP0808X
IN71002832B364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health