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General NPI Number Information
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NPI Number | 1053976589
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Entity Type | Individual
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Provider Name | NICOLE MARIE BANKS ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 9910 LEVIN RD NW STE 200
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City | SILVERDALE
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State | WA
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Zip | 98383-7789
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Country | US
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Telephone | 360-692-8588
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Fax | 360-692-7030
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Provider Business Mailing Address
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Address Line | 17310 CITORI PL NW
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City | POULSBO
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State | WA
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Zip | 98370-9593
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Country | US
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Telephone | 360-265-8781
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | AP60956115
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License Number State | WA
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