Individual
IDA M BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
210 9TH ST SE, ROCHESTER, MN 55904-6756
(507) 288-3443
Mailing address
210 9TH ST SE, ROCHESTER, MN 55904-6756
(507) 288-3443
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R1401789
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
01
—
P00728940
RAILROAD MEDICARE
MN
Enumeration date
08/05/2008
Last updated
04/11/2017
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