Healthcare Provider Details

I. General information

NPI: 1558672352
Provider Name (Legal Business Name): LINDSEY WILLIS BANKS AU. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY MEGAN WILLIS

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 E VENICE AVE
VENICE FL
34285-9066
US

IV. Provider business mailing address

1360 E VENICE AVE
VENICE FL
34285-9066
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-2020
  • Fax: 941-484-2200
Mailing address:
  • Phone: 941-488-2020
  • Fax: 941-484-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: