Provider Demographics
NPI:1588286850
Name:BANKS, BRANDIE NICOLE (NP)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:NICOLE
Last Name:BANKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 WASHBURN ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5610
Mailing Address - Country:US
Mailing Address - Phone:907-215-1611
Mailing Address - Fax:
Practice Address - Street 1:9115 WASHBURN ST UNIT C
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5610
Practice Address - Country:US
Practice Address - Phone:907-215-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109665363LF0000X
AK189104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily