Healthcare Provider Details

I. General information

NPI: 1003425497
Provider Name (Legal Business Name): MELANIE BANKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 W WAYNE ST
PAULDING OH
45879-9235
US

IV. Provider business mailing address

1035 W WAYNE ST
PAULDING OH
45879-9235
US

V. Phone/Fax

Practice location:
  • Phone: 419-399-4080
  • Fax:
Mailing address:
  • Phone: 419-399-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027293
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: