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General NPI Number Information
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NPI Number | 1932982774
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Entity Type | Individual
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Provider Name | ANITA RENEE BANKS
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Gender | Female
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 10620 E 66TH ST 161
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City | TULSA
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State | OK
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Zip | 74133-2608
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Country | US
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Telephone | 918-698-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 23 E ROSS AVE
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City | SAPULPA
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State | OK
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Zip | 74066-6423
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Country | US
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Telephone | 918-216-4999
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Fax | 918-216-4998
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | L0063704
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License Number State | OK
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