Healthcare Provider Details

I. General information

NPI: 1437145265
Provider Name (Legal Business Name): BRANDEE DANKS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 S PACIFIC HWY
MEDFORD OR
97501-8957
US

IV. Provider business mailing address

3617 S PACIFIC HWY
MEDFORD OR
97501-8957
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-6239
  • Fax: 541-535-4377
Mailing address:
  • Phone: 541-535-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01010
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: