Healthcare Provider Details

I. General information

NPI: 1912829771
Provider Name (Legal Business Name): TYPHANNIE PATRICE BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

8114 S MAY ST
CHICAGO IL
60620-3006
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-1600
  • Fax:
Mailing address:
  • Phone: 773-502-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.397460
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: