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NPI Code Detail

MEDICARE: KHADIJAH BANKS

MEDICARE: KHADIJAH BANKS
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
1164W00000XLicensed Practical NurseTGPN036365PA

General Provider Information

NPI Number : 1649077751
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHADIJAH BANKS
Provider Business Mailing Address
First Line : 6765 GERMANTOWN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-2111
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6765 GERMANTOWN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-2111
Country : US
Telephone Number : 215-409-7426
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2025
Last Update Date : 02/26/2025

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Directions to “ KHADIJAH BANKS ” Practice Location

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