Healthcare Provider Details

I. General information

NPI: 1326295643
Provider Name (Legal Business Name): ELAINE KAREN WILLBANKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14314 SW ALLEN BLVD 313
BEAVERTON OR
97005-4403
US

IV. Provider business mailing address

14314 SW ALLEN BLVD 313
BEAVERTON OR
97005-4403
US

V. Phone/Fax

Practice location:
  • Phone: 503-349-2401
  • Fax:
Mailing address:
  • Phone: 503-349-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number095000623RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: