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NPI Code Detail

MEDICARE: SHAMIKA BANKS

MEDICARE: SHAMIKA 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
1302R00000XHealth Maintenance Organization

General Provider Information

NPI Number : 1962801837
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAMIKA BANKS
Provider Business Mailing Address
First Line : 2609 RAINBOW GLOW ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-3709
Country : US
Telephone Number : 702-561-0866
Fax Number :
Provider Business Practice Location Address
First Line : 2609 RAINBOW GLOW ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-3709
Country : US
Telephone Number : 702-561-0866
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2014
Last Update Date : 08/17/2014

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Directions to “ SHAMIKA BANKS ” Practice Location

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