| NPI | 1750565438 |
|---|---|
| Former Name | SUSAN MARIE BANKSTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AK 106370) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 20090027NP) |
| 363L00000X Nurse Practitioner (Licence: OR 20090027NP) | |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2016-03-31 |