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General NPI Number Information
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NPI Number | 1053098244
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Entity Type | Individual
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Provider Name | ALEXIS MARIE BANKS RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 112 KANSAS ST
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City | FRANKFORT
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State | IL
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Zip | 60423-1447
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Country | US
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Telephone | 630-450-7295
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Fax |
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Provider Business Mailing Address
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Address Line | 2788 VILLAGE GREEN DR APT B2
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City | AURORA
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State | IL
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Zip | 60504-5284
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Country | US
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Telephone | 630-450-7295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164008873
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License Number State | IL
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