Provider Demographics
NPI:1730869801
Name:BANKS, DARNETTA F
Entity type:Individual
Prefix:
First Name:DARNETTA
Middle Name:F
Last Name:BANKS
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 1:16232 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2913
Mailing Address - Country:US
Mailing Address - Phone:313-268-1755
Mailing Address - Fax:
Practice Address - Street 1:16232 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2913
Practice Address - Country:US
Practice Address - Phone:313-268-1755
Practice Address - Fax:313-341-2804
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker