Provider Demographics
NPI:1386243707
Name:BANKS, DEONTA
Entity type:Individual
Prefix:
First Name:DEONTA
Middle Name:
Last Name:BANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WV
Mailing Address - Zip Code:26704-4508
Mailing Address - Country:US
Mailing Address - Phone:304-496-8918
Mailing Address - Fax:
Practice Address - Street 1:95 N RIVER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WV
Practice Address - Zip Code:26704-4508
Practice Address - Country:US
Practice Address - Phone:304-496-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant