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General NPI Number Information
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NPI Number | 1295935880
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Entity Type | Individual
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Provider Name | CAROL ANN BANKS R.N.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 420 W FOURTH STREET SUITE 100-A
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City | MISHAWAKA
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State | IN
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Zip | 46544-1948
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Country | US
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Telephone | 574-252-0309
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Fax | 574-472-3694
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Provider Business Mailing Address
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Address Line | PO BOX 6489
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City | SOUTH BEND
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State | IN
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Zip | 46660-6489
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Country | US
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Telephone | 574-472-6700
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 28120528A
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License Number State | IN
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