Provider Demographics
NPI:1780356584
Name:BANKHEAD, ARIANA (RN)
Entity type:Individual
Prefix:MS
First Name:ARIANA
Middle Name:
Last Name:BANKHEAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2976 TRIVERTON PIKE DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5840
Mailing Address - Country:US
Mailing Address - Phone:414-552-7872
Mailing Address - Fax:
Practice Address - Street 1:2976 TRIVERTON PIKE DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5840
Practice Address - Country:US
Practice Address - Phone:414-552-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI247490-30163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice