Provider Demographics
NPI:1851127237
Name:BANKS, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name: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 1:429 NEW QUARTERS RD
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:WV
Mailing Address - Zip Code:26404-7216
Mailing Address - Country:US
Mailing Address - Phone:314-917-8672
Mailing Address - Fax:
Practice Address - Street 1:503 MORGANTOWN AVE STE 120
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4384
Practice Address - Country:US
Practice Address - Phone:304-363-7375
Practice Address - Fax:304-471-2488
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker