Provider Demographics
NPI:1588899975
Name:BANKS, CHERRON LYNNETTE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CHERRON
Middle Name:LYNNETTE
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 1:5202 KENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45427-2219
Mailing Address - Country:US
Mailing Address - Phone:937-268-5958
Mailing Address - Fax:
Practice Address - Street 1:5202 KENTWOOD RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45427-2219
Practice Address - Country:US
Practice Address - Phone:937-268-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.132543-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse