Provider Demographics
NPI:1699028381
Name:LEFTRIDGE-BANKS, D'ANN NORVELLE
Entity type:Individual
Prefix:MS
First Name:D'ANN
Middle Name:NORVELLE
Last Name:LEFTRIDGE-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 1:4049 CASTLE COVE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-6308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:702-224-4729
Practice Address - Street 1:4049 CASTLE COVE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-6308
Practice Address - Country:US
Practice Address - Phone:702-224-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1699028381225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor