Healthcare Provider Details

I. General information

NPI: 1124141437
Provider Name (Legal Business Name): NANCY M BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 N COUNTY ROAD 11
TIFFIN OH
44883-9104
US

IV. Provider business mailing address

2861 N COUNTY ROAD 11
TIFFIN OH
44883-9104
US

V. Phone/Fax

Practice location:
  • Phone: 419-618-1622
  • Fax:
Mailing address:
  • Phone: 419-618-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN246094
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: