Provider Demographics
NPI:1205589744
Name:HUNTERBANKS, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HUNTERBANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 RISING SUN RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117-4331
Mailing Address - Country:US
Mailing Address - Phone:540-872-6915
Mailing Address - Fax:
Practice Address - Street 1:234 RISING SUN RD
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117-4331
Practice Address - Country:US
Practice Address - Phone:540-872-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver