Healthcare Provider Details

I. General information

NPI: 1588819940
Provider Name (Legal Business Name): VICKI BANKS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICKI MCMILLAN

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6085 N 85TH AVE
GLENDALE AZ
85305-2565
US

IV. Provider business mailing address

5501 N 19TH AVE 310
PHOENIX AZ
85015-2450
US

V. Phone/Fax

Practice location:
  • Phone: 623-877-4004
  • Fax:
Mailing address:
  • Phone: 601-433-1344
  • Fax: 602-249-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1381
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1381
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: