Healthcare Provider Details

I. General information

NPI: 1902716806
Provider Name (Legal Business Name): BREANNA BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E ROME BLVD UNIT 3084
NORTH LAS VEGAS NV
89084-1418
US

IV. Provider business mailing address

140 E ROME BLVD UNIT 3084
NORTH LAS VEGAS NV
89084-1418
US

V. Phone/Fax

Practice location:
  • Phone: 702-502-8096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: