Individual
NICOLE LORAINE BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2945 S DOBSON RD, MESA, AZ 85202-7941
(480) 969-4138
Mailing address
6140 E FAIRFIELD ST, MESA, AZ 85205-5963
(480) 232-9039
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
AZ
363AS0400X
Surgical Physician Assistant
Primary
—
AZ
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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