MEDICARE: LIA BANKA MSN, FNP-C

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	163W00000X	Registered Nurse	UQMI1VS2	NC
2	363LF0000X	Family Nurse Practitioner	5021022	NC

General Provider Information

NPI Number	:	1699418822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIA BANKA MSN, FNP-C

Provider Business Mailing Address
First Line	:	203 CAPCOM AVE STE 104
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-6514
Country	:	US
Telephone Number	:	919-276-4005
Fax Number	:	919-276-4010

Provider Business Practice Location Address
First Line	:	203 CAPCOM AVE STE 104
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-6514
Country	:	US
Telephone Number	:	919-276-4005
Fax Number	:	919-276-4010

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

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	04/07/2026

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