Provider Demographics
NPI:1770064198
Name:BANKS, BRENDA T (LPN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:T
Last Name:BANKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 OLIVET CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-7506
Mailing Address - Country:US
Mailing Address - Phone:843-430-8602
Mailing Address - Fax:
Practice Address - Street 1:2647 OLIVET CEMETERY RD
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-7506
Practice Address - Country:US
Practice Address - Phone:843-430-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18124164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse