Provider Demographics
NPI:1932982774
Name:BANKS, ANITA RENEE
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:RENEE
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 1:23 E ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6423
Mailing Address - Country:US
Mailing Address - Phone:918-216-4999
Mailing Address - Fax:918-216-4998
Practice Address - Street 1:10620 E 66TH ST
Practice Address - Street 2:161
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2608
Practice Address - Country:US
Practice Address - Phone:918-698-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0063704164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse