Healthcare Provider Details

I. General information

NPI: 1487818472
Provider Name (Legal Business Name): VERONICA W BANKS RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PETERBORO ST
DETROIT MI
48201-2722
US

IV. Provider business mailing address

2735 PRINCE HALL DR
DETROIT MI
48207-3300
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-3160
  • Fax: 313-831-2604
Mailing address:
  • Phone: 313-937-1714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704374111
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: