Individual
MARIELVA BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10343 INDIANAPOLIS BLVD STE 104, HIGHLAND, IN 46322
(219) 513-4258
Mailing address
10343 INDIANAPOLIS BLVD STE 104, HIGHLAND, IN 46322-3639
(219) 513-4258
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085006321
IL
363AM0700X
Medical Physician Assistant
Primary
10002646B
IN
Other
Enumeration date
08/03/2017
Last updated
11/15/2019
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