Provider Demographics
NPI:1699418822
Name:BANKA, LIA (FNP-C)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:BANKA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LIA
Other - Middle Name:MICHELLE
Other - Last Name:KENYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, FNP-C
Mailing Address - Street 1:605 W HOLDING AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2848
Mailing Address - Country:US
Mailing Address - Phone:802-578-7342
Mailing Address - Fax:
Practice Address - Street 1:605 W HOLDING AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2848
Practice Address - Country:US
Practice Address - Phone:802-578-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCUQMI1VS2163W00000X
NC5021022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse