MEDICARE: LISA MICHELLE BANKE NP

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	363LF0000X	Family Nurse Practitioner	95007529	CA

General Provider Information

NPI Number	:	1275048159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MICHELLE BANKE NP

Provider Business Mailing Address
First Line	:	6999 ARROYO RD
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94550-9642
Country	:	US
Telephone Number	:	925-784-9253
Fax Number	:

Provider Business Practice Location Address
First Line	:	6999 ARROYO RD
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94550-9642
Country	:	US
Telephone Number	:	925-784-9253
Fax Number	:

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

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	12/13/2017

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