Individual
CRISTEN RENEE BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4505 N ROCKWOOD DR STE 1, PEORIA, IL 61615-3815
(309) 589-1880
Mailing address
3602 MARQUETTE RD, PERU, IL 61354-1990
(815) 223-7400
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
209023920
IL
363L00000X
Nurse Practitioner
Primary
209023920
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209023920
DEPT OF FINANCIAL AMD PROFESSIONAL REGULATION
IL
Enumeration date
09/02/2021
Last updated
09/16/2021
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