Healthcare Provider Details

I. General information

NPI: 1336653724
Provider Name (Legal Business Name): ADRIANA AVA BANKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WHITE HORSE PIKE # 4158
CLEMENTON NJ
08021-4158
US

IV. Provider business mailing address

1337 PADDOCK WAY
CHERRY HILL NJ
08034-2937
US

V. Phone/Fax

Practice location:
  • Phone: 856-583-2400
  • Fax:
Mailing address:
  • Phone: 609-346-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR12835000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01430100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: