MEDICARE: MRS. ERICA A BANES WHNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	2002005691	MO
2	363LW0102X	Women's Health Nurse Practitioner	2002005691	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2002005691	OTHER	MO	MISSOURI STATE LISCENSE

General Provider Information

NPI Number	:	1437300555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERICA A BANES WHNP

Provider Business Mailing Address
First Line	:	3023 N BALLAS RD STE 600D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2332
Country	:	US
Telephone Number	:	314-996-4880
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 N BALLAS RD STE 600D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2332
Country	:	US
Telephone Number	:	314-996-4880
Fax Number	:

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

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/06/2021

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