MEDICARE: LONNESHIA BANKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1255620415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNESHIA BANKS

Provider Business Mailing Address
First Line	:	5188 GREENE LN APT C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-1725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5188 GREENE LN APT C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-1725
Country	:	US
Telephone Number	:	702-722-7230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	07/14/2011

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Directions to “ LONNESHIA BANKS ” Practice Location

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