MEDICARE: TYISHA BANKS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN-156365	OH

General Provider Information

NPI Number	:	1346652724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYISHA BANKS LPN

Provider Business Mailing Address
First Line	:	3327 YORKSHIRE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2530
Country	:	US
Telephone Number	:	216-385-3544
Fax Number	:

Provider Business Practice Location Address
First Line	:	3327 YORKSHIRE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2530
Country	:	US
Telephone Number	:	216-385-3544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	05/20/2014

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