=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679918692
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRIELLE L. BANKS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2013
-----------------------------------------------------
Last Update Date | 09/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 JEFFERSON HWY
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-842-4747
-----------------------------------------------------
Fax | 504-842-1242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 66 MELROSE DR
-----------------------------------------------------
City | DESTREHAN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70047-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-621-7041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 122898-7291
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------